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CVS Health Pharmacist - Clinical Operations Advisor (PBM) in Austin, Texas

Job Description

This position is 100% work from home and can be located anywhere in the United States. The Pharmacist - Clinical Operations Advisor is a client facing roleaccountable for the design of the client formulary andutilization management programs in partnership the HealthPlan (HP) Clinical Advisor, Benefit Relationship Manager,and Formulary 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 the efficiency and accuracy of clinical set ups.The Clinical Operational Advisor supports internal and client audits of clinical set ups within adjudication systems, which includes verifying the client approved requirements and design.The Clinical Operations Advisor should be able to manage multiple HP clients across multiple lines of business including Medicare, Medicaid, Exchange, and Commercial. This position can be located in a Corporate Hub or has the ability to work remotely/work from home within the U.S. Clinical Operations Advisor must have the ability to travel up to 30% of the time.

Required Qualifications

Pharmacist - Clinical Operations Advisor must have the ability to travel up to 30% of the time.3+ years as a corporate pharmacist, data analytical role and or experience working as a consultative pharmacist Registered Pharmacist with current license

COVID Requirements

COVID-19 Vaccination Requirement

CVS Health requires its Colleagues in certain positions 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, pregnancy, or religious belief that prevents them from being vaccinated.

  • If you are 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 within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.

  • If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications

Client facing consultant experience


Registered Pharmacist in with current licenseB.S. or doctorate of pharmacy degree is required.

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.