At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.A Brief Overview
Applies highly developed skills to create and maintain clinical content for drugs covered under the pharmacy and medical benefit, working with business partners and product teams to identify, develop, and monitor the impact of programs on supporting drug coverage through the pharmacy and medical benefit.
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What you will do
- Evaluates, researches and develops evidence-based clinical content related to drugs, including drug profiles, therapeutic guidelines, formulary management strategies, and coverage criteria for Medicare Part D.
- Collaborates with the formulary management team to assess and recommend drug inclusion/exclusion based on clinical evidence, safety, efficacy, and cost-effectiveness, ensuring alignment with clinical content..
- Conducts thorough clinical assessments of new drugs, drug utilization trends, and emerging therapeutic classes to provide informed recommendations for inclusion in formularies and benefit tiers.
- Creates and refines coverage criteria and prior authorization guidelines to ensure appropriate utilization of medications, supporting cost-effective and evidence-based prescribing.
- Works closely with business partners, including product teams, medical directors, actuarial teams, and legal/compliance departments, Medicare teams, to align clinical strategies with Medicare business goals and ensure compliance with regulatory requirements.
- Monitors the impact of clinical programs and interventions on drug utilization, patient outcomes, and cost savings. Analyzes data to identify trends and opportunities for continuous improvement.
- Stays current with evolving healthcare policies, Medicare regulations, and market dynamics that impact drug coverage, reimbursement, and access and provides insights to inform strategic decision-making.
- Contributes to quality improvement initiatives by participating in clinical audits, quality assurance activities, and performance assessments to ensure the accuracy and consistency of clinical content.
- Develops educational materials, such as drug monographs, clinical summaries, and training materials, to assist internal teams, healthcare providers, and customers in understanding clinical aspects of covered drugs.
- 3+ years pharmacist experience in the managed care space
- Demonstrated Medicare Part D utilization management experience
- Registered Pharmacist (RPh) in good standing with no restrictions
- Mastery of problem solving and decision making skills.
- Mastery of collaboration and teamwork
- Mastery of growth mindset (agility and developing yourself and others) skills
- Mastery of execution and delivery (planning, delivering, and supporting) skills
- Ability to consider the relative costs and benefits of potential actions to choose the most appropriate option.
- Ability to function in clinical setting with diverse cultural dynamics of clinical staff and patients.
- Mastery knowledge of phases of care transitions and resources available for patients.
- BS in Pharmacy or PharmD
40Time Type
Full timePay Range
The typical pay range for this role is:$118,000.00 - $206,250.00This 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.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.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.