[Hiring] Clinical Advisor @CVS Health

Role Description

The Health Plan Clinical Advisor is a client facing role that manages the clinical relationship by influencing multiple key decision makers at a health plan. These include the health plan’s pharmacy support team, pharmacists, medical directors, CMO as well as other senior health plan leaders.

The Health Plan Clinical Advisor should be able to manage at least 2 and up to 4 market segments for any particular client (Medicare, Medicaid, Exchange, or Commercial).

The Health Plan Clinical Advisor is responsible for proactively managing the clinical relationship alongside the business lead (SAE/SAD) to understand and drive each of their client’s priorities, financial targets, clinical goals and other commitments to their leadership.

The Health Plan Clinical Advisor will analyze and evaluate the client’s data and competitive marketplace conditions and forces to develop and execute a comprehensive business plan that supports the client’s short- and long-term profitability and growth strategies. Key components include:

• Collaborating with clients on analysis of their key marketplace competitors and those products and services.
• Consulting with and recommending standard and custom formulary options and utilization management edits.
• Collaborating with internal partners to develop or modify custom programs or formularies that meet the unique needs of health plan clients.
• Collaborating with CVSH trade partners on formulary strategies to maximize rebate value and drive lowest net cost.
• Consulting with and recommending utilization management programs or other clinical programs to a client.
• Consulting with and recommending specialty drug strategy options.
• Consulting with ANCS to utilize clinical and financial reports to evaluate current benefit design and provide recommendations to clients on any opportunities.
• Consulting and influencing clients on current drug trends, drug pipeline, as well as proactive monitoring of FWA trends.
• Consulting and influencing clients on a regular basis, developing a trusted consultative partnership that drives client loyalty and fulfills both clients commitments and CVSH goals.
• Conducting Provider and Member outreach as needed for client communications.

The Health Plan Clinical Advisor will consult with and advise the Clinical Benefits Pharmacist, and or other members of the Benefits and Operations teams so that those teams can timely and accurately implement a client’s requirements.

The Health Plan Clinical Advisor will collaborate with CVSH internal partners to ensure compliance to any federal, state or local regulatory requirements that impact formulary, UM and or clinical programs and consult with any clients on the impact that such requirements might have on their plan.

The Health Plan Clinical Advisor is accountable for ensuring that CVSH meets or exceeds any health plan client value targets each year and is responsible for proactively collaborating with business leads to identify client value and then provide consultative advice and follow up with the client on such recommendations. Consultative advice may include:

• Recommendations for program pilots.
• Modification to existing CVSH programs to support the unique needs of the health plan segment and marketplace.
• How CVSH as an enterprise can support health plans through our open source model.

The Health Plan Clinical Advisor is responsible for ensuring they meet or exceed their personal and departmental client satisfaction scores target each year.

This position can be located in a CVSH Corporate Hub or can work remotely/work from home within the United States. Clinical Advisors must have the ability and willingness to travel up to 50% of the time.

Qualifications

• 3+ years of managed care Pharmacist experience and/or 1 year of Managed Care Residency program.
• Active pharmacist license that is in good standing.
• Demonstrated experience in a client-facing role within the managed care environment.
• Demonstrated understanding of and experience with utilization management trends and programs within the managed care environment.
• Highly organized, detail oriented, proficient analytical ability with effective listening & presentation skills.

Requirements

• 3-5 years of 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.
• Proven leadership skills.
• Strong business acumen.
• Commitment to client service and relationship building.
• Experience implementing template and/or customized clinical programs.
• Knowledge of PBM adjudication engine and other systems leveraged in support of clients.
• AMCP Fundamentals of Managed Care Pharmacy Certificate or similar professional advancement.

Benefits

• Comprehensive and competitive mix of pay and benefits.
• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.