Clinical Pharmacist - Medicare at CVS Health | The Muse (2024)

This individual will be responsible for:

• Performing pharmacy reviews and making evidence-based recommendations regarding Medicare members
• Identifying opportunities within the health plan for integration of quality measures in current case management or other clinical programs
• Communicate to providers, pharmacies, and members on quality, STARs, or FWA indicators for Medicare programs
• Provide clinical pharmacy support to programs targeted toward the Medicare membership
• Actively participate and collaborate as part of the multidisciplinary team to improve member's medication regimen and overall health

Additional responsibilities may include, but not limited to:

• Supporting FWA through research and outreach to prescribers, pharmacies, and members on identified cases for target medications
• Analyzing data, claims, and clinical literature on appropriate utilization, making outreach calls/faxes, as well as organizing, and documenting all relevant interactions
• Aid non-pharmacist (technician) support staff working in the Therapeutic Duplication and Formulary Alternative Outreach Program for Medicare Part D Medications
• Helping to support new or pilot programs, or lines of business as needed

This is a remote role open to qualified candidates within the United States.

Required Qualifications:

• Current unrestricted state pharmacist license in state of residence
• Live in and be licensed in a state that allows clinical services to be performed in a work from home position
• 3+ years in a Clinical Pharmacist Role which must include at least one of the following:
  • Rounding and/or making therapy recommendations as an active part of a multi-disciplinary care team
  • Independently managing patient therapy under a collaborative practice agreement
  • One year of a Pharmacy Practice Residency
  • Board Certified Ambulatory Care Pharmacist, Board Certified Geriatric Pharmacist, or Board-Certified Pharmacotherapy Specialist
  • At least 3 months in a recent Medicare Managed Care Clinical Pharmacy Role focused on Stars or HEDIS measures

• Ability to research and analyze medication literature including drug information, disease states, and clinical practice guidelines to identify appropriate utilization for medications identified for Fraud, Waste, and Abuse
• Familiarity with compendia such as Micromedex, Lexicomp, Clinical Pharmacology, UpToDate, etc.
• Excellent communication skills to handle complex conversations, with ability to interact directly with providers (including specialists in their field) to drive appropriate/formulary aligned prescribing

Clinical Pharmacist Role:

• Established experience in functions beyond fundamentaldispensing and order-processing activities such as optimization of medication selection, dosing, and monitoring
• Experience with population health and/or disease state management
• Ability to research and analyze medication literature including drug information, disease states, and clinical practice guidelines to identify gaps in care and create/communicate a recommendation plan to providers.

Preferred Qualifications:

• Certified in MTM
• Ability to research state laws and regulations by utilizing state Board of Pharmacy (BOP) websites
• Prior experience working with FWA, regulatory, or auditing programs
• 1-3 years Medicare managed care experience
• Experience with Medicare STARS and Part D Formulary benefits
• Knowledge of clinical program components, formulary designs, prescription benefit trends
• Previous leadership experience
• Fluent in Russian, Vietnamese, or Spanish
• Working knowledge of Microsoft suite of programs including Outlook, Teams, Word, and Excel

Education and Certification Requirements:

Bachelor's in Pharmacy or PharmD, with an active unrestricted Pharmacist license in state of residence

Pay Range

The typical pay range for this role is:

$87,035.00 - $187,500.00

This pay range represents the base hourly rate or base annual full-time 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 short-term incentive program in addition to the base pay range listed above.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

CVS Health requires certain 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, religious belief, or other legally recognized reasons that prevents them from being 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 or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through ColleagueRelations@CVSHealth.com If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.