Pharmacist \u2013 Utilization Management Clinical Development Advisor

Job Description
CVS Health has an exciting opportunity to join our growing team as a Pharmacist - Medical Affairs Advisor.

As the Pharmacist - Medical Affairs Advisor you will supervise and coordinate the development and maintenance of Utilization Management (UM) programs: prior authorization, step therapy and quantity limits needed for the Commercial, Medicaid, & Exchange business. The Clinical Advisor must have the ability to lead meetings and projects that support programs for these lines of business. The Clinical Advisor will act as a liaison with Clinical Affairs, Formulary Administration, Clinical Operations, Clinical Advisors, and other business partners to ensure all programs accurately support clinical and ethical standards. The Clinical Advisor must work to continually improve the workflow of the UM team and the criteria development process in support of enterprise initiatives, as well as identify and resolve challenges by review of data and root cause analysis. The Clinical Advisor must adapt project plan priorities to address resource capacity

The Clinical Advisor will direct the Medical Affairs Residency program including recruiting, interview process, rotation assignments, residency projects, conference attendance, and ongoing coaching of the Pharmacy Residents. Residency responsibilities subject to change.

Key Responsibilities:
1. Knowledge of regulations regarding UM and Formulary products and services and the Coverage Determination, Redetermination and Audit process.
2. Knowledge of medical literature retrieval and review, clinical program development, PBM and benefit design experience.
3. Ability to interpret, evaluate, and utilize medical information to develop and enhance UM and other clinical programs.
4. Provide clinical information support to internal and external customers.
5. Provide clinical content and development support for cross functional projects to meet business needs.
6. Problem solve
7. Required: PC Office software including Excel, Word, & PowerPoint, Access

This position requires knowledge and experience with prior authorization, strong clinical and analytical skills including clinical research and drug information, previous Residency program experience, and active pharmacist licensure in good standing.

Required Qualifications
Active pharmacist license that is in good standing
5 plus years experience in the healthcare industry or related experience
2 years plus clinical pharmacy experience

Preferred Qualifications
Knowledge of UM program creation, submission and audit experience.
Pharmacy Practice Residency

Bachelor or Doctorate Degree, Pharmacy

Business Overview
At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.