Pharmacist - Clinical Operations Advisor

1w1 week ago

CVS Health

US · Full-time · $110,925 – $228,800

About this role

We’re building a world of health around every individual—shaping a more connected, convenient and compassionate health experience. At CVS Health, the Clinical Operations Advisor is a client-facing role that collaborates with HP Clinical Advisor to understand the client’s clinical strategy and roadmap. Join passionate colleagues who innovate with purpose and prioritize safety and quality.

The Clinical Operations Advisor works with the Benefit Relationship Manager and client to facilitate gathering formulary and utilization management requirements. 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 role manages multiple health plan clients across Medicare, Medicaid, Exchange, and Commercial lines.

Designs clinical set ups using Caremark technology solutions and supports coding teams in loading clinical data into the adjudication system. Partners with account team members to document clinical design best practices and identify opportunities to improve efficiency and accuracy. Supports internal and client audits of clinical set ups within adjudication systems.

This position can be located in a CVSH Corporate Hub or work remotely within the United States. Must have ability to travel up to 5% of the time. Help simplify health care one person, one family and one community at a time.

Requirements

Pharmacist – 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 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
Attention to detail to ensure data fidelity and data integrity including business rules for data transformation

Responsibilities

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