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SalaryJob Description
The FEP PA Clinical Advisor provides clinical support and process guidance to the PA department staff. Acts is a liaison between the PA department, FEP Clinical Account team and the other internal CVS/Caremark departments providing service to FEP members. Administration of OPM Appeals processes and providing support to the OPM and FEP Team. Provides assistance with member escalations and validates that procedures are followed correctly. Assists in the creation of clinical criteria and works with the FEP Clinical Development Manager to present this information to the client. Oversees the processes for foreign claim research requests and non-PA reconsideration requests. The Clinical Advisor is responsible for managing the relationship with the PA database vendor and acts as project manager for system enhancements. Acts as a liaison with the Medicare Part D team on administering the EGWP benefit for FEP members. Provides oversight of the department policy and procedure submission to the corporate repository. Responsible for the maintenance of the FEP PA Master Coding document. Provides clinical research and analysis for ad hoc client requests.
As a Clinical Advisor, your success will be driven by maintaining above average client satisfaction scores and contributing to the account team’s ability to increase client revenue relative to clinical programs and solutions. You will partner and serve as a liaison with internal teams and other clinicians supporting clinical programs on behalf of the client to achieve these results. Superior writing and organizational skills as well as the ability to meet tight deadlines will also be paramount to your success. The contributions you will make as a Clinical Advisor will position CVS Health for long term growth in the competitive PBM marketplace.
This is a hybrid, WFH flexible model role open to candidates in commutable distance of our Phoenix, AZ office.
Pay Range
The typical pay range for this role is:
Minimum: 84,500
Maximum: 182,000
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
1. Minimum of 3 years of managed care experience applicable to the role or 1 year of CVS Health or other Managed Care Residency program
2. PC literacy
3. Excellent oral & written communication skills
4. Experience with pharmacy intervention programs and drug utilization review, completion
5. Proven leadership skills
6. Active non-restricted pharmacist license that is in good standing in state of residence. Active non-restricted pharmacist license in state of Arizona is desirable.
7. Experience supporting business specific to Medicare Part D/EGWP, Medicaid, Exchange and/or Commercial
8. Proficiency in using Microsoft applications, especially Excel, PowerPoint, and Word
9. Excellent presentation and oral/written communication skills
10. Commitment to client service and relationship building
11. Ability to travel limited to no more than 20% of the time. Travel may require but is not limited to flights, overnight stays, local travel, travel on short notice and other travel deemed necessary by the Company.
Preferred Qualifications
1 -2 years of experience supporting Pharmacy Benefit Management (PBM) clients or within Medicare Part D/EGWP field
Expertise in Utilization Management and Formulary Management
Knowledge of PBM adjudication engine and other systems leveraged in support of clients
Working knowledge of the different drug compendia adopted in PBM work
Strong business acumen
Experience in a client-facing role
Ability to work on multiple projects, prioritize, and resolve complex problems
Experience implementing template and/or customized formularies and clinical programs
Ability to learn multiple internal reporting and analytic tools for client management
AMCP Fundamentals of Managed Care Pharmacy Certificate or similar professional advancement
Education
Bachelor of Science, Pharmacy or PharmD
Business Overview
Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected 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.
The FEP PA Clinical Advisor provides clinical support and process guidance to the PA department staff. Acts is a liaison between the PA department, FEP Clinical Account team and the other internal CVS/Caremark departments providing service to FEP members. Administration of OPM Appeals processes and providing support to the OPM and FEP Team. Provides assistance with member escalations and validates that procedures are followed correctly. Assists in the creation of clinical criteria and works with the FEP Clinical Development Manager to present this information to the client. Oversees the processes for foreign claim research requests and non-PA reconsideration requests. The Clinical Advisor is responsible for managing the relationship with the PA database vendor and acts as project manager for system enhancements. Acts as a liaison with the Medicare Part D team on administering the EGWP benefit for FEP members. Provides oversight of the department policy and procedure submission to the corporate repository. Responsible for the maintenance of the FEP PA Master Coding document. Provides clinical research and analysis for ad hoc client requests.
As a Clinical Advisor, your success will be driven by maintaining above average client satisfaction scores and contributing to the account team’s ability to increase client revenue relative to clinical programs and solutions. You will partner and serve as a liaison with internal teams and other clinicians supporting clinical programs on behalf of the client to achieve these results. Superior writing and organizational skills as well as the ability to meet tight deadlines will also be paramount to your success. The contributions you will make as a Clinical Advisor will position CVS Health for long term growth in the competitive PBM marketplace.
This is a hybrid, WFH flexible model role open to candidates in commutable distance of our Phoenix, AZ office.
Pay Range
The typical pay range for this role is:
Minimum: 84,500
Maximum: 182,000
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
1. Minimum of 3 years of managed care experience applicable to the role or 1 year of CVS Health or other Managed Care Residency program
2. PC literacy
3. Excellent oral & written communication skills
4. Experience with pharmacy intervention programs and drug utilization review, completion
5. Proven leadership skills
6. Active non-restricted pharmacist license that is in good standing in state of residence. Active non-restricted pharmacist license in state of Arizona is desirable.
7. Experience supporting business specific to Medicare Part D/EGWP, Medicaid, Exchange and/or Commercial
8. Proficiency in using Microsoft applications, especially Excel, PowerPoint, and Word
9. Excellent presentation and oral/written communication skills
10. Commitment to client service and relationship building
11. Ability to travel limited to no more than 20% of the time. Travel may require but is not limited to flights, overnight stays, local travel, travel on short notice and other travel deemed necessary by the Company.
Preferred Qualifications
1 -2 years of experience supporting Pharmacy Benefit Management (PBM) clients or within Medicare Part D/EGWP field
Expertise in Utilization Management and Formulary Management
Knowledge of PBM adjudication engine and other systems leveraged in support of clients
Working knowledge of the different drug compendia adopted in PBM work
Strong business acumen
Experience in a client-facing role
Ability to work on multiple projects, prioritize, and resolve complex problems
Experience implementing template and/or customized formularies and clinical programs
Ability to learn multiple internal reporting and analytic tools for client management
AMCP Fundamentals of Managed Care Pharmacy Certificate or similar professional advancement
Education
Bachelor of Science, Pharmacy or PharmD
Business Overview
Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected 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.
