Clinical Pharmacist - Medicare Formulary
About the position
The Clinical Pharmacist engages within the Medical Affairs team to support the development and management of Medicare formularies and utilization management (UM) programs and the formulary/UM management systems for the enterprise. This role is pivotal in ensuring compliance with new rules and regulations while addressing requests from both internal and external customers. The Clinical Pharmacist is responsible for the creation and maintenance of CVS Caremark's standard and client-modified formularies, as well as utilization management programs and policies, ensuring clinical appropriateness, accuracy, and consistency across the board. In addition to these responsibilities, the Clinical Pharmacist will support the immediate team by connecting, training, and assisting colleagues in understanding business rules and their applications. Key tasks include the preparation of CMS formulary files and drug lists, providing guidance to internal partners for implementing downstream clinical activities, and supporting various formulary and utilization management processes. The role also involves interfacing with other teams and leadership to support product development, enterprise formulary initiatives, and additional clinical activities based on organizational and marketplace needs. This position is hybrid, requiring in-office presence three days a week, with the flexibility to work from home on the remaining days. Candidates must reside within a commutable distance to one of the specified office locations: Buffalo Grove, IL; Pittsburgh, PA; Solon, OH; Scottsdale, AZ; or Cumberland, RI.
Responsibilities
Engage with the Medical Affairs team to support Medicare formularies and utilization management programs.
,
Create and maintain CVS Caremark's standard and client-modified formularies.
,
Ensure clinical appropriateness, accuracy, and consistency in formulary management.
,
Support the immediate team by connecting, training, and assisting colleagues.
,
Prepare CMS formulary files and formulary drug lists.
,
Provide direction to internal partners for implementing clinical activities.
,
Support formulary and utilization management processes and requests.
,
Interface with other teams and leadership for product development and enterprise initiatives.
Requirements
3+ years of experience in a Health Care setting (PBM or managed care environment) or completion of managed care residency.
,
Active pharmacist license in good standing.
,
Demonstrated experience with formulary management and Medicare Part D.
,
Strong clinical skills.
,
Proficiency in MS Office Suite including Access, Excel, PowerPoint, and Visio.
,
Knowledge of PBM and Managed Care, Formulary Management, Utilization Management, Drug File and Adjudication, and Pharmacy and Therapeutics Committee decision-making process.
Nice-to-haves
Pharmacy Practice or Managed Care residency.
,
Deep experience with Medicare Part D.
,
Knowledge of regulatory environment and applicable standards.
,
Excellent oral and written communication skills.
,
Excellent organizational skills.
,
Ability to resolve problems by influencing or motivating others.
,
Demonstrated ability to think strategically.
Benefits
Full range of medical, dental, and vision benefits.
,
401(k) retirement savings plan.
,
Employee Stock Purchase Plan.
,
Fully-paid term life insurance plan.
,
Short-term and long-term disability benefits.
,
Well-being programs.
,
Education assistance and free development courses.
,
CVS store discount and discount programs with participating partners.
,
Paid Time Off (PTO) and paid holidays.
Apply Now
The Clinical Pharmacist engages within the Medical Affairs team to support the development and management of Medicare formularies and utilization management (UM) programs and the formulary/UM management systems for the enterprise. This role is pivotal in ensuring compliance with new rules and regulations while addressing requests from both internal and external customers. The Clinical Pharmacist is responsible for the creation and maintenance of CVS Caremark's standard and client-modified formularies, as well as utilization management programs and policies, ensuring clinical appropriateness, accuracy, and consistency across the board. In addition to these responsibilities, the Clinical Pharmacist will support the immediate team by connecting, training, and assisting colleagues in understanding business rules and their applications. Key tasks include the preparation of CMS formulary files and drug lists, providing guidance to internal partners for implementing downstream clinical activities, and supporting various formulary and utilization management processes. The role also involves interfacing with other teams and leadership to support product development, enterprise formulary initiatives, and additional clinical activities based on organizational and marketplace needs. This position is hybrid, requiring in-office presence three days a week, with the flexibility to work from home on the remaining days. Candidates must reside within a commutable distance to one of the specified office locations: Buffalo Grove, IL; Pittsburgh, PA; Solon, OH; Scottsdale, AZ; or Cumberland, RI.
Responsibilities
Engage with the Medical Affairs team to support Medicare formularies and utilization management programs.
,
Create and maintain CVS Caremark's standard and client-modified formularies.
,
Ensure clinical appropriateness, accuracy, and consistency in formulary management.
,
Support the immediate team by connecting, training, and assisting colleagues.
,
Prepare CMS formulary files and formulary drug lists.
,
Provide direction to internal partners for implementing clinical activities.
,
Support formulary and utilization management processes and requests.
,
Interface with other teams and leadership for product development and enterprise initiatives.
Requirements
3+ years of experience in a Health Care setting (PBM or managed care environment) or completion of managed care residency.
,
Active pharmacist license in good standing.
,
Demonstrated experience with formulary management and Medicare Part D.
,
Strong clinical skills.
,
Proficiency in MS Office Suite including Access, Excel, PowerPoint, and Visio.
,
Knowledge of PBM and Managed Care, Formulary Management, Utilization Management, Drug File and Adjudication, and Pharmacy and Therapeutics Committee decision-making process.
Nice-to-haves
Pharmacy Practice or Managed Care residency.
,
Deep experience with Medicare Part D.
,
Knowledge of regulatory environment and applicable standards.
,
Excellent oral and written communication skills.
,
Excellent organizational skills.
,
Ability to resolve problems by influencing or motivating others.
,
Demonstrated ability to think strategically.
Benefits
Full range of medical, dental, and vision benefits.
,
401(k) retirement savings plan.
,
Employee Stock Purchase Plan.
,
Fully-paid term life insurance plan.
,
Short-term and long-term disability benefits.
,
Well-being programs.
,
Education assistance and free development courses.
,
CVS store discount and discount programs with participating partners.
,
Paid Time Off (PTO) and paid holidays.
Apply Now