CVS Health is a health care innovation company. Together, we are are helping people on their path to better health.
CVS Health has an exciting opportunity to join our growing team as a Pharmacist – Clinical Operations.
This position can be located at any CVS Corporate Hub . Additionally, this position has the ability to be 100% remote work from home.
As the Pharmacist – Clinical Operations you will have the ability to be in a client facing role accountable for the design of the client formulary and utilization management programs in partnership the HP Clinical Advisor, Benefit Relationship Manager, and Formulary Administration.
You will collaborate with HP 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 set up for projects on the operations
plan while ensuring compliance to internal best practice
and federal and state guidelines. This includes:
o Completing the clinical data analysis to design an
optimal formulary and utilization management
o Collaborating with the Benefit Relationship Manager and
Formulary Administration to clarify client clinical
requirements to design and develop formulary and
utilization management edits
o Reviewing and obtaining approval from client on the
design of formulary and utilization management
o Consulting and influencing the client on standard and
custom formulary options and utilization management edits
o Reviewing identified defects during testing and helping to
resolve these defects, including consulting with the client
to re-define and clarify the clinical requirements
o Collaborating with internal partners to develop
automation strategies and perform user acceptance testing
o Ensuring timely delivery of formulary and utilization
management edits, including reviewing the test results with
o Meeting and/or exceeding CVSH yearly goals, including
meeting and/or exceeding client service levels for
turnaround times and accuracy
o Consulting with clients and developing a trusted
consultative partnership that drives up client satisfaction
The Clinical Operations Advisor designs the clinical set
ups using Caremark technology solutions and supports the
coding teams in the loading of clinical data into the
adjudication system (RxClaims). The Clinical Operations Advisor partners with clinical team members to document
clinical design best practices, provide inputs 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,
which includes verifying the client approved requirements
The Clinical Operations Advisor should be able to manage
multiple HP clients across multiple lines of business
including Medicare, Medicaid, Exchange, and Commercial.
Active pharmacist license that is in good standing in State of residence
• Proven knowledge of Medicare, Medicaid, Exchange, and or Commercial and industry trends
• 1+ years exp Microsoft applications – excel, power point, word, outlook, access, teams
Proven Ability To:
• 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
• Ability to work on multiple projects, prioritize, and resolve
• Effectively work independently without daily supervision
• Impact and influence others
• Drive results and deliver on goals and commitments
• Facilitate cross functional communication and
COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
• 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
• Knowledge of PBM adjudication engine and other
systems leveraged in support of clients
• Proven leadership skills
• Commitment to client service and relationship building
3 + years relevant experience
• CVS internal reporting and analytic tools for client
management or industry equivalent
PharmD or equivalent
Active Registered Pharmacist license in at least 1 state
Bring your heart to CVS Health
Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand – with heart at its center – our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.