Pharmacist - Clinical Operations Advisor

CVS Health

19h•Hybrid

About The Position

The Clinical Operations Advisor is a client facing role that collaborates with HP Clinical Advisor to understand the client’s clinical strategy and roadmap to create a clinical operations plan. This role works with the Benefit Relationship Manager and client to facilitate gathering formulary and utilization management requirements and designs the drug level set up for projects on the operations plan, ensuring compliance to internal best practice and federal and state guidelines. The Clinical Operations Advisor designs clinical set ups using Caremark technology solutions and supports coding teams in loading clinical data into the adjudication system. The position 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 set ups. The Clinical Operational Advisor supports internal and client audits of clinical set ups within adjudication systems, including verifying client approved requirements and design. This role requires the ability to manage multiple health plan clients across various lines of business including Medicare, Medicaid, Exchange, and Commercial. The position can be located in a CVSH Corporate Hub or has the ability to work remotely/work from home within the United States, with up to 5% travel required.

Requirements

Active Registered Pharmacist license in at least 1 state
3+ years prior relevant work experience as a pharmacist in managed care (PBM) environment and/or completion of PGY1 managed care residency
Demonstrated understanding of CVSH clinical portfolio, marketplace segments dynamics (Medicare, Medicaid, Exchange, and or Commercial) and industry trends
Proficiency with Microsoft applications - Excel, PowerPoint, Word, Outlook, Access, Teams
Demonstrated experience with CVSH internal reporting and analytic tools for client management or PBM 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

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
Proven leadership skills
Commitment to client service and relationship building

Responsibilities

Collaborate with HP Clinical Advisor to understand the client’s clinical strategy and roadmap to create a clinical operations plan
Work with the Benefit Relationship Manager and client to facilitate gathering formulary and utilization management requirements
Design the drug level set up for projects on the operations plan while ensuring compliance to internal best practice and federal and state guidelines
Design the clinical set ups using Caremark technology solutions
Support the coding teams in the loading of clinical data into the adjudication system
Partner with account team members to document clinical design best practices
Provide input to streamline processes
Identify opportunities to improve the efficiency and accuracy of clinical set ups
Support internal and client audits of clinical set ups 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