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You will be updated with latest job alerts via email$ 118000 - 206250
1 Vacancy
At CVS Health were building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nations leading health solutions company we reach millions of Americans through our local presence digital channels and more than 300000 purposedriven colleagues caring for people where when and how they choose in a way that is uniquely more connected more convenient and more compassionate. And we do it all with heart each and every day.
A Brief Overview
Applies highly developed skills to create and maintain clinical content for covered under the pharmacy and medical benefit working with business partners and product teams to identify develop and monitor the impact of programs on supporting drug coverage through the pharmacy and medical benefit.
What you will do
Evaluates researches and develops evidencebased clinical content related to including drug profiles therapeutic guidelines formulary management strategies and coverage criteria for Medicare Part D.
Collaborates with the formulary management team to assess and recommend drug inclusion/exclusion based on clinical evidence safety efficacy and costeffectiveness ensuring alignment with clinical content..
Conducts thorough clinical assessments of new drug utilization trends and emerging therapeutic classes to provide informed recommendations for inclusion in formularies and benefit tiers.
Creates and refines coverage criteria and prior authorization guidelines to ensure appropriate utilization of medications supporting costeffective and evidencebased prescribing.
Works closely with business partners including product teams medical directors actuarial teams and legal/compliance departments Medicare teams to align clinical strategies with Medicare business goals and ensure compliance with regulatory requirements.
Monitors the impact of clinical programs and interventions on drug utilization patient outcomes and cost savings. Analyzes data to identify trends and opportunities for continuous improvement.
Stays current with evolving healthcare policies Medicare regulations and market dynamics that impact drug coverage reimbursement and access and provides insights to inform strategic decisionmaking.
Contributes to quality improvement initiatives by participating in clinical audits quality assurance activities and performance assessments to ensure the accuracy and consistency of clinical content.
Develops educational materials such as drug monographs clinical summaries and training materials to assist internal teams healthcare providers and customers in understanding clinical aspects of covered .
This is a hybrid role based out of either our Buffalo Grove IL or Pittsburgh PA office locations. Colleague would work 3 days per week in office with the ability to work remotely the other 2 days. Must reside in commutable distance to Buffalo Grove IL or Pittsburgh PA.
For this role you will need Minimum Requirements
3 years pharmacist experience in the managed care space
Demonstrated Medicare Part D utilization management experience
Registered Pharmacist (RPh) in good standing with no restrictions
Mastery of problem solving and decision making skills.
Mastery of collaboration and teamwork
Mastery of growth mindset (agility and developing yourself and others) skills
Mastery of and delivery (planning delivering and supporting) skills
Ability to consider the relative costs and benefits of potential actions to choose the most appropriate option.
Ability to function in clinical setting with diverse cultural dynamics of clinical staff and patients.
Mastery knowledge of phases of care transitions and resources available for patients.
Education
BS in Pharmacy or PharmD
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$118000.00 $206250.00This pay range represents the base hourly rate or base annual fulltime 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 shortterm 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 our comprehensive and competitive mix of pay and benefits investing in the physical emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages our great benefits include:
Affordable medical plan options a 401(k) plan (including matching company contributions) and an employee stock purchase plan.
Nocost programs for all colleagues including wellness screenings tobacco cessation and weight management programs confidential counseling and financial coaching.
Benefit solutions that address the different needs and preferences of our colleagues including paid time off flexible work schedules family leave dependent care resources colleague assistance programs tuition assistance retiree medical access and many other benefits depending on eligibility.
For more information visit anticipate the application window for this opening will close on: 04/28/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal state and local laws.
Full-Time