Pharmacist - Clinical Operations Advisor

CVS Health•Work At Home-Texas, VT

4d•$110,925 - $228,800•Remote

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 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
Bachelor Degree in Pharmacy required
Active, unrestricted pharmacist licensure required

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
PharmD preferred

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.
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.
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.
Manages multiple health plan clients across multiple lines of business including Medicare, Medicaid, Exchange, and Commercial.
Analyzes large volume of clinical data and organizes this data for downstream teams such as configuration and testing teams.
Ensures data fidelity and data integrity is well understood including the business rules for data transformation.
Works on multiple projects, prioritizes, and resolves complex problems.
Works independently without daily supervision.
Facilitates cross functional communication and collaboration.
Consults and influences internal stakeholders and client contacts.