CVS Health Senior Advisor, Formulary Administration Pharmacist - Medicare (WFH) in Solon, Ohio
The Senior Advisor is responsible for providing strategic and operational leadership and support for the development, implementation, and evaluation of Medicare Part D formularies, drug lists, and utilization management. This individual leads and supports creation and maintenance of formularies and utilization management, preparation of CMS formulary files and member formulary drug lists, preparation and review of updates for implementation, and other formulary and utilization management related processes and requests. The role requires strong cross functional collaboration, communication and project management skills and a deep understanding of Medicare Part D formulary management and related processes and applicable CMS rules and regulations.The successful candidate must have qualifications to successfully perform the following responsibilities:1. Lead and support development, implementation, and evaluation of Medicare Part D formularies, drug lists, and utilization management (e.g. oversee and evaluate pipeline and drug file changes, evaluate and provide formulary, drug list, utilization management and Part D status recommendations, enter and track decisions and data, analyze data, prepare documentation for internal business approvals, prepare and review formulary and utilization management updates for implementation).2. Lead and support establishment and maintenance of clinical framework, business rules, and policies and procedures for Medicare Part D Formulary management.3. Lead and support preparation of files for annual and monthly CMS formulary submissions and member formulary drug lists.4. Provide clinical subject matter expertise and support for internal and external stakeholders and customers and for other formulary and utilization management-related processes, analyses, projects, project plans, requests and issues as needed. Provide support in IT related projects as needed.5. Interface with colleagues in other internal departments as needed regarding formulary, drug list, utilization management and drug file maintenance, including cross-functional collaboration to reach consensus on clinically related matters supporting formulary development.
-Licensed pharmacist in state of residency-Strong clinical and analytic skills and knowledge.-In depth knowledge and experience in of Formulary Management in the Medicare environment and the CMS formulary submission process, including seven (7) years experience in a Managed Care environment, five (5) years of Medicare D experience, and strong knowledge of CMS regulatory requirements.-The ideal candidate will either live in or willing to relocate to the following locations: Scottsdale, AZ, Buffalo Grove, IL, Solon, OH, Pittsburgh, PA, Woonsocket RI.
CVS Health requires its 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, 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 10 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 45 days of your employment. In some states and roles, you may be required to provide proof of full vaccination before you can begin to actively work. 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, or religious belief, you will be required to apply for a reasonable accommodation within the first 10 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. In some states and roles, you may be required to have an approved reasonable accommodation before you can begin to actively work. If your request for an accommodation is not approved, then your employment may be terminated.
Doctor of Pharmacy (or equivalent experience)PGY1 Pharmacy ResidencyBoard Certification (any discipline)Knowledge of RxCLAIM system formulary and UM setup-Ability to identify opportunities, define approach, develop project plans and oversee implementation of formulary related projects and services.-Ability to work with large data sets, analyze data and provide recommendations based on the analysis.-Ability to research, analyze, interpret and apply rules and regulations. -Strong strategic thinking and ability to distill strategic concepts into actionable tactics.-Strong organizational and communication skills, and ability to conduct meetings and lead colleagues and cross-functional teams. Confidence in articulating issues and recommendations to management.-Able to work across boundaries and locations, manage multiple complex projects, have attention to detail, meet timelines for deliverables, and understand the impacts of their function to the organization, clients, and plan participants.-PC skills; Proficient in MS Word, Excel, Access and Power Point.
Bachelors Degree in Pharmacy or Doctor of Pharmacy
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.
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