Position Summary:CVS Health has an exciting opportunity to join our growing team as a Clinical Operations Pharmacist. This position is open to any location, even work from home.
As a Clinical Operations Pharmacist with a focus on our Medicare Line of Business, you will use a combination of your operational and clinical knowledge to assist the account team and client by providing oversight and systems expertise. As the Clinical Operations Pharmacist you will ensure the client intent is applied and tested for clinical and benefit changes. You will play a lead role in supporting the implementation of client specific clinical and government programs. Additionally you will translate marketplace and client information into the adjudication system. You will provide the opportunity to utilize clinical and operational skills in a managed care environment to positively impact the health of consumers while helping reduce health care costs.
We offer a competitive benefit package which includes, but is not limited to, Paid Time Off, 10 holidays per year, health/dental/vision insurance, employee discounted stock purchase program, 401K, and a generous employee discount at all CVS stores.
Join CVS Health ... where "Health is Everything! Required Qualifications: * Medicare Part D knowledge
* CMS guidance around formulary and UM
* Transition Fill
* Calendar cycle of events
* Negative change process
* Part D vs. Part B vs. Excluded drugs
* GPI and NDC level benefit administration
* Proficient in Excel, including some advanced capabilities such as Vlookup, Pivot table, if/then functions, conditional formatting
* General understanding of compliance and the critical nature of adherence
* Good communication skills to facilitate inter-departmental collaboration
* 1+ years in a PBM or Managed Care setting
* 1+ year using MS Word, Excel, and Outlook, with experience creating and updating Excel spreadsheets
* This position requires an active Pharmacist license Preferred Qualifications: * EGWP specific knowledge
* Commercial benefit knowledge (understanding how these formularies wrap around the Primary
Med D benefit)
* Audit experience
* General knowledge of Coverage Determination, Appeals and Grievance process
* Specialty drug knowledge (CMS cost threshold definition vs. CVS “specialty” drug
* Experience with member facing documents (formulary, member disruption)
* Review/validation of test data
* Drug Search Tool
Education: Bachelor of science in Pharmacy
Pharm D preferred
This position requires a Pharmacist license in the state you reside Business Overview:
CVS Health, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units – MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.
CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law. CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW
and EEO IS THE LAW SUPPLEMENT
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance to apply for this job, please contact us by clicking AA EEO CVS Health
For inquiries related to the application process or technical issues please contact the Kenexa Helpdesk at 1-855-338-5609. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352. Please note that we only accept resumes via our corporate website: https://jobs.cvshealth.com/