Clinical Pharmacist - FEP/MQA (AZ Licensed)

CVS Health•Mesa, AZ

4d•$105,000 - $176,000•Hybrid

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The RPh Advisor supports the clinical operations of the Member Quality Assurance Commercial and Medicare Part D fraud, waste, and abuse program for a national client. The program's goal is to identify, prevent, and resolve inappropriate drug utilization, identify negative trends, refer potentially fraudulent activity to the MQA investigators, remain compliant with the Drug Management Program for CMS. The RPh Advisor works with a diverse departmental staff which includes Professional Investigators, Data Analysts, and Clinical Assistants. Responsibilities include clinical review of plan member profiles for FWA, managing the Overutilization Taper program, submission of specific cases to vendor for External Peer Review (EPR), assistance with program and system enhancements, securing client satisfaction and retention, and working cross functionally with client and internal partners to help identify and resolve FWA issues. The RPh communicates directly with the client on a regular basis regarding status of program.

Requirements

Licensed Pharmacist in the state of Arizona
Excellent verbal and written communication skills
Well organized with the ability to effectively prioritize work
Customer focused
Ownership and results driven
Attention to detail
Proficient use Microsoft Office applications, e.g. Outlook, Excel, Word
Ability to effectively work within a team
Flexible in adapting to change
Ability to effectively plan, prioritize, organize time and workload
Skilled in identifying and solving issues and recommending process improvements
Ability to work successfully in a deadline-oriented environment
Must be able to communicate in a professional demeanor and maintain high confidentiality standards

Nice To Haves

Previous experience supporting federal and/or state government clients.
Previous experience working on fraud, waste and abuse issues for clients.

Responsibilities

Clinical review of plan member profiles for FWA
Managing the Overutilization Taper program
Submission of specific cases to vendor for External Peer Review (EPR)
Assistance with program and system enhancements
Securing client satisfaction and retention
Working cross functionally with client and internal partners to help identify and resolve FWA issues
Communicates directly with the client on a regular basis regarding status of program