CVS Health Pharmacist - Clinical Operations Advisor in Houston, Texas
This is a remote, work from home role open to candidates anywhere in the United States.The Clinical Operations Advisor is a client facing roleaccountable for the design of the client formulary andutilization management programs in partnership the HPClinical Advisor, Benefit Relationship Manager, andFormulary Administration.The Clinical Operations Advisor collaborates with HPClinical Advisor to understand the client’s clinical strategyand roadmap to create a clinical operations plan. TheClinical Operations Advisor works with the BenefitRelationship Manager and client to facilitate gatheringformulary and utilization management requirements anddesigns the drug level set up for projects on the operationsplan while ensuring compliance to internal best practiceand federal and state guidelines. This includes:o Completing the clinical data analysis to design anoptimal formulary and utilization managemento Collaborating with the Benefit Relationship Manager andFormulary Administration to clarify client clinicalrequirements to design and develop formulary andutilization management editso Reviewing and obtaining approval from client on thedesign of formulary and utilization managemento Consulting and influencing the client on standard andcustom formulary options and utilization management editso Reviewing identified defects during testing and helping toresolve these defects, including consulting with the clientto re-define and clarify the clinical requirementso Collaborating with internal partners to developautomation strategies and perform user acceptance testingas requiredo Ensuring timely delivery of formulary and utilizationmanagement edits, including reviewing the test results withthe cliento Meeting and/or exceeding CVSH yearly goals, includingmeeting and/or exceeding client service levels forturnaround times and accuracyo Consulting with clients and developing a trustedconsultative partnership that drives up client satisfactionThe Clinical Operations Advisor designs the clinical setups using Caremark technology solutions and supports thecoding teams in the loading of clinical data into theadjudication system (RxClaim). The Clinical OperationsAdvisor partners with clinical team members to documentclinical design best practices, provide inputs to streamlineprocesses, and identify opportunities to improve theefficiency and accuracy of clinical set ups.The Clinical Operational Advisor supports internal andclient audits of clinical set ups within adjudication systems,which includes verifying the client approved requirementsand design.The Clinical Operations Advisor should be able to managemultiple HP clients across multiple lines of businessincluding Medicare, Medicaid, Exchange, and Commercial.This position can be located in a CVSH Corporate Hub orhas the ability to work remotely/work from home within theU.S. Clinical Operations Advisor must have the ability totravel up to 5% of the time if needed.
The typical pay range for this role is:
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
- Active pharmacist license that is in good standingrequired- 2+ years pharmacist experience in managed care environment - 1+ years pharmacist experience in a clinical operations role- Strong proficiency with Excel- Strong analytical knowledge
COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
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, FormularyManagement and Clinical Products• Experience implementing template and/or customizedclinical programs• Knowledge of PBM adjudication engine and othersystems leveraged in support of clients• Proven leadership skills• Commitment to client service and relationship building
BS or Pharm D in Pharmacy
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