Pharmacist - Clinical Operations Advisor

CVS Health • Ohio, IL

30d • Remote

About The Position

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position SummaryThe Clinical Operations Advisor is a client facing role that collaborates with Health Plan Clinical Advisor to understand the client's clinical strategy and roadmap to create a clinical operations plan. The Clinical Operations Advisor works with the Benefit Relationship Manager and client to facilitate gathering formulary and utilization management requirements and designs the drug level setup for projects on the operations plan while ensuring compliance to internal best practice and federal and state guidelines.The Clinical Operations Advisor designs the clinical setups using Caremark technology solutions and supports the coding teams in the loading of clinical data into the adjudication system. The Clinical Operations Advisor partners with account team members to document clinical design best practices, provide input to streamline processes, and identify opportunities to improve the efficiency and accuracy of clinical setups. The Clinical Operations Advisor supports internal and client audits of clinical setups within adjudication systems, which includes verifying the client approved requirements and design.The Clinical Operations Advisor should be able to manage multiple health plan clients across multiple lines of business including Medicare, Medicaid, Exchange, and Commercial.This is a remote role, open to qualified candidates within the Central or Eastern time zones of the United States. Clinical Operations Advisor must have the ability to travel up to 5% of the time.

Requirements

• Active Registered Pharmacist license in state of residence
• 2-3+ years prior relevant work experience as a pharmacist in managed care (Pharmacy Benefit Management) environment
• Demonstrated understanding of CVSH clinical portfolio, marketplace segments dynamics (Medicare, Medicaid, Exchange, and or Commercial) and industry trends
• Demonstrated experience with Utilization Management and Formulary Management in managed care environment
• Demonstrated experience in a client-facing role within PBM environment
• Proficiency with Microsoft applications - Excel, PowerPoint, Word, Outlook, Access, Teams
• Demonstrated experience with CVSH internal reporting and analytic tools for client management or industry equivalent
• Excellent written and verbal communication skills both virtually and in person
• Ability to analyze large volume of clinical data and organize this data for downstream teams such as configuration and testing teams
• Attention to detail to ensure data fidelity and data integrity is well understood including the business rules for data transformation
• Ability to work on multiple projects, prioritize, and resolve complex problems
• Effectively work independently without daily supervision
• Impact and influence others
• Drive results and deliver on goals and commitments
• Facilitate cross functional communication and collaboration
• Consult and influence internal stakeholders and client contacts
• Ability to travel up to 5% of the time.

Nice To Haves

• Experience supporting Pharmacy Benefit Management (PBM) clients or within a health plan
• Experience in all market segments (Medicare, Medicaid, Exchange and Commercial)
• Expertise in Utilization Management, Formulary Management and Clinical Products
• Experience implementing template and/or customized clinical programs
• Knowledge of PBM adjudication engine and other systems leveraged in support of clients
• RxClaim experience
• Proven leadership skills
• Commitment to client service and relationship building

Responsibilities

• Collaborates with Health Plan Clinical Advisor to understand the client's clinical strategy and roadmap to create a clinical operations plan.
• Works with the Benefit Relationship Manager and client to facilitate gathering formulary and utilization management requirements and designs the drug level setup for projects on the operations plan while ensuring compliance to internal best practice and federal and state guidelines.
• Designs the clinical setups using Caremark technology solutions and supports the coding teams in the loading of clinical data into the adjudication system.
• Partners with account team members to document clinical design best practices, provide input to streamline processes, and identify opportunities to improve the efficiency and accuracy of clinical setups.
• Supports internal and client audits of clinical setups within adjudication systems, which includes verifying the client approved requirements and design.
• Manage multiple health plan clients across multiple lines of business including Medicare, Medicaid, Exchange, and Commercial.

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Ambulatory Health Care Services
• Number of Employees: 5,001-10,000 employees