Senior Clinical Pharmacist, Medical Affairs - Clinical Innovation and Regulatory Strategy

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven 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.

Position Summary
The Senior Clinical Pharmacist, Medical Affairs - Clinical Innovation and Regulatory Strategy identifies opportunities and best practices in the development and maintenance of programs supported by Medical Affairs, drives the regulatory strategy of UM programs and supports regulatory compliance activities for Medical Affairs.  This includes accountability and support for utilization management (UM), formulary development, regulatory audits and clinical analytics.  The Senior Clinical Pharmacist works cross-functionally to ensure clinical accuracy and adherence to ethical practices and compliance with MHPAEA, CMS, DOI regulations reflecting the interests of Medical Affairs. This role requires knowledge of pharmacy benefit management programs and services across multiple channels. The Senior Clinical Pharmacist will be comfortable and proficient in leading contributions supporting standard and customized clinical services for CVS Caremark products.

This is a hybrid role based out of our Pittsburgh, PA, Buffalo Grove, IL, or Scottsdale, AZ office locations. Candidate must reside in commutable distance to one of these locations.

Key Responsibilities:

Clinical Program Support Services

• Development, management and evaluation of Medical Affairs clinical programs and regulatory strategies.
• Provide oversight and clinical review of projects ensuring consistency with best practices and ethical standards.
• Facilitate cross-functional work teams to ensure accurate representation of clinical content and regulatory statutes.
• Lead the implementation of key priorities in CASA to improve performance and efficiencies.
• Manage the maintenance and external requests of Medical Affairs UM Policies and Procedures.
• Support Clinical Program Review Committee meetings.
• Perform as Medical Affairs Ambassador across organization by supporting all Heartbeat page maintenance throughout Medical Affairs.
• Work with the Lead Director of Clinical information, Analytics and Regulatory Compliance to ensure equitable application of UM across medical/surgical and behavioral health therapies.

Regulatory Strategy & Compliance

• Facilitate initiatives to ensure clinical programs (formulary, UM criteria) comply with MHPAEA, CMS, and DOI regulations.
• Lead audit readiness and response activities for PBM market conduct exams, Mental Health Parity, CMS audits, and internal regulatory reviews.
• Drive the completion and compliance of the NQTL Library creation and annual review activities.

Analytics, Metrics & Program Performance

• Support analytics activities and collaborations to measure and communicate the value of clinical programs.
• Analyze large datasets to identify trends and identify opportunities for clinical program optimization and improvement.
• Assist in the development of business cases and value models to forecast and track program performance and benefits realization.

Cross-Functional & Strategic Collaboration

• Represent Medical Affairs in cross-functional forums, key initiatives, projects and planning sessions.
• Ability to comprehend clinical vision and communicate direction within and outside of Medical Affairs.
• Ability to engage stakeholders and define contributions to make clinical program development successful.

Required Qualifications

• PharmD/RPh or equivalent clinical pharmacy degree
• Active pharmacist license in good standing
• 7+ years of experience in regulatory pharmacy, managed care, or PBM operations
• 3+ years of professional experience in reviewing and evaluating data and trends
• Strong understanding of MHPAEA, CMS regulations, and audit processes
• Demonstrated leadership, organizational and planning skills.
• Excellent communication and stakeholder engagement skills
• Ability to work in an agile environment to support the needs of Medical Affairs as they arise.
• Comprehensive understanding of managed care, PBM services and customers.

Preferred Qualifications

• Experience with healthcare data sources, including pharmacy and medical claims
• Familiarity w