[Hiring] Clinical Advisor - Academic Detailer @CVS Health

Role Description

The Academic Detailer/Clinical Advisor is a unique and high-impact pharmacist role combining clinical expertise, Medicare knowledge, data insights, and provider-facing communication skills. In this role, you will partner directly with a Medicare Advantage Health Plan to optimize formulary utilization, guide providers through preferred product selection, and support members in receiving the safest, most cost-effective therapies.

You will serve as a front-line clinical expert—educating prescribers, influencing prescribing behavior, identifying cost and quality opportunities, and ensuring the drug benefit is delivered in a clinically sound and financially responsible manner. This includes leveraging data, engaging directly with physicians, and aligning PBM and health plan strategies to drive superior outcomes.

This role is ideal for a pharmacist with PBM or health plan experience, strong knowledge of Medicare Part D rules, and exceptional communication and analytical skills. This is a remote role, open to qualified candidates within the United States. Candidate must be willing and able to travel up to 40% of the time to meet business needs.

Key Responsibilities

• Clinical Strategy & Formulary Optimization
  • Serve as the clinical subject matter expert for Medicare Part D formulary, utilization management, and preferred product strategy.
  • Analyze drug utilization, trends, prescriber behavior, and savings opportunities at the plan, provider, and member level.
  • Identify and implement strategies to drive preferred product adoption, biosimilar conversion, generic utilization, and gross-to-net optimization.
  • Translate complex rebate, pricing, and utilization concepts into clear recommendations for both providers and health plan partners.
• Provider Engagement & Academic Detailing
  • Conduct direct outreach to prescribers via phone, virtual sessions, and in-person visits to influence safe, cost-effective prescribing.
  • Deliver concise clinical messages on preferred alternatives, formulary pathways, safety considerations, and affordability.
  • Educate providers on coverage determination processes, PA submissions, documentation requirements, and Medicare rules.
  • Build strong relationships with prescribers, provider groups, and health plan clinical teams to reduce avoidable denials and improve member experience.
• Medicare Part D & Utilization Management Expertise
  • Apply expert-level understanding of CMS guidelines, HPMS memos transition rules, tiering exceptions, and benefit requirements.
  • Support providers in navigating Coverage Determinations (CDs), Prior Authorizations (PAs), redeterminations, and appeals.
  • Assist in the identification and correction of common PA submission patterns that lead to denials.
• Data Interpretation & Reporting
  • Partner with analytics teams to develop and deliver monthly, quarterly, and annual clinical reporting for the Health Plan.
  • Use internal reporting tools (e.g., analytics dashboards, claims systems) to produce actionable insights.
  • Present clinical and financial outcomes to health plan and PBM leadership, showcasing progress and impact.
• Cross-Functional Collaboration
  • Work closely with PBM stakeholders, health plan pharmacy leadership, FWA teams, formulary operations, specialty teams, and network partners.
  • Identify opportunities to reduce fraud, waste, and abuse and improve overall drug program performance.
  • Participate in strategy meetings, benefit reviews, provider initiatives, and clinical program deployment.
• Leadership & Representation
  • Represent Caremark and the Health Plan in provider meetings, care team discussions, and cross-functional initiatives.
  • Support implementation of new clinical programs, benefit changes, and formulary updates.
  • Travel for onsite provider visits, health plan meetings, and targeted field engagement as required (up to 40%).

Qualifications

• Active, unrestricted pharmacist licensure
• 5+ years of clinical experience, ideally including at least 1 year in a PBM, Health Plan, or Managed Care residency program.
• Strong demonstrated understanding of Medicare Part D benefit design, UM criteria, coverage determinations, and formulary management.
• Exceptional oral, written, and interpersonal communication skills.
• Proficiency in Microsoft tools and comfort working with data, dashboards, and reporting systems.
• Ability to travel up to 40% for provider engagement and onsite Health Plan needs.

Preferred Qualifications

• 3+ years direct experience in PBM, Health Plan, or Managed Care pharmacy in a client-facing role.
• Experience influencing prescribers, conducting academic detailing, or leading provider education initiatives.
• Strong analytical skills with ability to explain net cost, rebates, preferred product strategy, and clinical impact in simple terms.
• Ability to manage multiple high-visibility projects simultaneously and work autonomously.
• Familiarity with AMCP frameworks; AMCP Fundamentals of Managed Care Pharmacy Certificate strongly preferred.
• Comfort preparing provider-facing materials, clinical talking points, or formulary change communications.

Education

• BS in Pharmacy or PharmD

Anticipated Weekly Hours

• 40

Time Type

• Full time

Pay Range

The typical pay range for this role is: $110,925.00 - $228,800.00. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

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.

We anticipate the application window for this opening will close on: 05/11/2026. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.