[Hiring] Clinical Advisor Pharmacist @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). This role will have Medicare as the primary line of business responsibilities.

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 role includes:

• 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.
• Consulting with regulatory and legal teams to advise clients of compliance within regulations.
• Helping the client to define clinical program strategies around STARS and quality initiatives (i.e., MTM, CAHPS, STARS, Part B and C where applicable, SUPD, etc.).
• Consulting with and advising the Clinical Benefits Pharmacist, and/or other members of the Benefits and Operations teams to ensure timely and accurate implementation of a client’s requirements.
• Collaborating with CVSH internal partners to ensure compliance with 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.
• Accountable for ensuring that CVSH meets or exceeds any health plan client value targets each year.
• Proactively collaborating with business leads to identify client value and provide consultative advice and follow-up with the client on such recommendations.
• 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 U.S. Clinical Advisors must have the ability to travel up to 25% 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

• 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). Medicare will be the primary focus of this role.
• 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

• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.

Company Description

We’re building a world of health around every individual — shaping a more connected, convenient, and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable, and prioritize safety and quality in everything we do.

Our people fuel our future. Our teams reflect the customers, patients, members, and communities we serve, and we are committed to fostering a workplace where every colleague feels valued and that they belong.