Remote Health Plan Clinical Advisor (Pharmacist)

CVS Health Corporation; Missouri; Hybrid; USD 111,000 - 250,000; Full time

Benefits offered by this job

Comprehensive benefits

Bonus program

Flexible work options

Job summary

CVS Health, a leading health services company, seeks a Health Plan Clinical Advisor to manage the clinical relationship with health plans and drive strategic initiatives. You will influence pharmacy support teams, medical directors, and senior leaders while addressing Medicare, Medicaid, Exchange, or Commercial segments.

You will lead cross-functional collaboration, analyze data, and propose formulary and utilization management strategies to reduce waste and maximize value.

Qualifications

• 3+ years in managed care pharmacy or 1 year in a Managed Care Residency
• Active pharmacist license in good standing
• Client-facing experience in a managed care environment
• Understanding of utilization management trends and programs
• Highly organized with strong analytical and presentation skills

Responsibilities

• Manage clinical relationships with health plan stakeholders and internal partners
• Develop and execute client business plans to drive profitability and growth
• Consult on formulary options and utilization management edits
• Collaborate on custom programs and formulary strategies to meet client needs
• Provide consultative guidance and monitor client satisfaction targets

Skills

Managed care pharmacy

Client-facing

Utilization management

Presentation skills

Analytical ability

Organizational skills

Education

BS in Pharmacy or PharmD

Active pharmacist license (1+ state)

Tools

PBM systems

Adjudication engine

Job description

CVS Health, a leading health services company, seeks a Health Plan Clinical Advisor to manage the clinical relationship with health plans and drive strategic initiatives. You will influence pharmacy support teams, medical directors, and senior leaders while addressing Medicare, Medicaid, Exchange, or Commercial segments.

You will lead cross-functional collaboration, analyze data, and propose formulary and utilization management strategies to reduce waste and maximize value.