Clinical Pharmacist - AMA Dual

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Position Summary

The Clinical Pharmacist - AMA Dual will be a multi-dimensional position; the primary areas of responsibility will include the following:

1.Complete Clinical Reviews and provide a determination of Medicare-Medicaid Coverage Determination/Redetermination, Medical Review, Global Exception etc. by reviewing all requests which are not clearly approvable based on specified criteria (algorithms).

2.Responsible for support and input to clinical programs such as: Health Management (IDT), Drug Utilization Review, Formulary development, and Prior Authorization programs to encourage appropriate, high quality, cost effective drug therapy; and to identify opportunities for improvement in efficiency, accuracy, and appropriateness of the programs in place.

3.Continually monitor the quality and efficiency of the Prior Authorization process including coverage criteria, denial language, and communication with prescribers and members. Provide recommendations to physicians to improve medication regimens as appropriate.

4.Provide input to clinical content of new programs and for maintenance of existing programs.

5.Complete all annual NCQA, Aetna required and Quarterly IRR training requirements.

6.Responsible for supporting / providing clinical expertise related to formulary decisions made by the Pharmacy and Therapeutics committee.

7.Assists Member Services and other internal customers in responding to and resolving pharmacy-related inquiries from members (NCQA Requirement).

8.Maintain open lines of communication with other functional areas/departments.

9.Responsible for staying current with clinical literature and guidelines and relaying those to the program development core teams.

Operational hours are M-F 6:30am-6pm AZ time, candidate will work 8 hour shifts within that timeframe with a Saturday rotation every 5th weekend. This is a remote role open to qualified candidates within the United States.

Required Qualifications

Proficiency in Microsoft Excel, Word, Outlook, and SharePoint

Superior written and verbal communication skills

1+ years managed care experience (Medicaid and/or Medicare) required

1+ year of previous clinical pharmacist experience required

Demonstrated understanding of clinical program components, formulary designs, and prescription benefit trends

Demonstrated experience with prior authorization coverage determination

Demonstrated experience with RxClaim

Active Registered Pharmacist license is required in State of Residence

Preferred Qualifications

3+ years of experience working as a licensed Pharmacist (3+ years managed care experience is highly desirable, but not required)

Education

Doctor of Pharmacy degree (Pharm.D.)

Pay Range

The typical pay range for this role is:

$87,035.00 - $187,500.00

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.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits.

Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.

As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 05/27/2024