We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
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.
This is a remote role open to qualified candidates within the United States. Team hours are M-F, 6:30am-6pm AZ time and colleague will be scheduled a regular shift during this timeframe once training is complete. On-call or weekend hours may be required post-training to meet business needs, current rotation requirement is every 5th weekend.
Required Qualifications
Demonstrated proficiency in Microsoft Excel, Word, Outlook, and SharePoint
Superior written and verbal communication skills
1+ year managed care pharmacist experience (Medicaid and/or Medicare) and/or completion of PGY1 managed care residency
1+ year of previous clinical pharmacy experience
Demonstrated knowledge of clinical program components, formulary designs, and prescription benefit trends
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
RxClaim experience
Proven success in a fast-paced, remote working environment
Education
Doctor of Pharmacy degree (Pharm.D.)
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$106,200.00 - $225,000.00This 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 people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- Demonstrated proficiency in Microsoft Excel, Word, Outlook, and SharePoint
- 1+ year managed care pharmacist experience (Medicaid and/or Medicare) and/or completion of PGY1 managed care residency
- 1+ year of previous clinical pharmacy experience
- Active Registered Pharmacist license in State of Residence
CVS Health Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about CVS Health and has not been reviewed or approved by CVS Health.
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Healthcare Strength — Healthcare coverage is positioned as comprehensive for benefits-eligible colleagues, including medical, dental, and vision with free preventive care and access to virtual care and select no-cost MinuteClinic services. Mental health support is also highlighted with no-cost confidential counseling sessions per issue.
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Retirement Support — Retirement benefits include a 401(k) with a dollar-for-dollar match up to 5% after meeting service and hours requirements. Ownership programs are also offered through an employee stock purchase plan with a stated purchase discount.
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Pay Growth & Progression — A companywide minimum wage floor establishes a baseline that is framed as a positive starting point in some roles and markets. Unionized or high-cost areas are described as having clearer wage scales and step-ups that can materially lift pay over time.
CVS Health Insights
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
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