Sr Clinical Pharmacist, Formulary Administration - Med D

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Position Summary

The Sr. Clinical Pharmacist is responsible for supporting the development, creation, maintenance, and management of CVS Caremark’s standard Medicare formularies, drug lists, utilization management, and other clinical programs and related processes, assuring clinical appropriateness, accuracy, clinical consistency, and full compliance with applicable rules and regulations. Responsibilities also include preparation of CMS formulary files and member formulary drug lists, providing direction to the internal partners to implement downstream clinical activities, and supporting other formulary and utilization management related processes and requests. The Sr. Clinical Pharmacist leads within the Medical Affairs team supporting Medicare formularies and external cross-functional teams to build consensus in Medicare formulary and utilization management decision-making process and continual enhancement of the clinical management systems for the enterprise. The role will lead clinical workstream activities within Medical Affairs and key stakeholders across the organization to support customer needs.

The Sr. Clinical Pharmacist role is responsible for leading across the Medical Affairs team and the broader organization, including connecting and directing other colleagues leveraging extensive knowledge as it relates to business rules and its applications. Responsibilities also include interfacing with other leaders (typically Director/VP and below) to support product development, enterprise formulary initiatives, and additional clinical activities based on the organizational and marketplace needs.

The Sr. Clinical Pharmacist role typically manages larger projects and processes and has the ability to evaluate work from an end-to-end perspective. The role provides measurable input into current and newly developed clinical products, support services, clinical standards and/or operational implementation and execution. The role has a direct impact on the clinical goals and objectives and the overall impact on achievement of results from both a short-term and a long-term perspective. The role requires the ability to work independently and apply appropriate judgement and discretion in leading often highly complex projects and/or clinical deliverables. In-depth advanced knowledge and clinical skills are required with the ability to understand the business application and the external healthcare marketplace dynamics.

This role requires a strong knowledge of PBM/managed care and Medicare formulary management including development and implementation and applicable CMS rules and regulations. The Sr. Clinical Pharmacist will need to think strategically, possess excellent clinical, communication, presentation, project management and time management skills to ensure all deliverables are aligned with broader strategies and project timelines. The role provides recommendations and influences strategic decision making.

This is a hybrid role, and will be based out of our Buffalo Grove, IL, Solon, OH, Pittsburgh, PA, Scottsdale, AZ, or Cumberland, RI office locations.

Required Qualifications

- 7+ years experience in managed care environment and/or completion of managed care residency

- Active pharmacist license that is in good standing

- Demonstrated experience with formulary management and Medicare Part D

Demonstrated understanding of:

• PBM and Managed Care

• Formulary Management

• Utilization Management

• Drug File and Adjudication

• Pharmacy and Therapeutics Committee decision making process

Skill In:

• Strong Clinical Skills

• MS Office Suite including Access, Excel, Power Point and Visio

Ability To:

• Prioritize and handle multiple projects

• Interpret concepts, data and general information into workable solutions and deliverables

• Work independently based on strategic direction requiring limited direction to complete assignments

• Plan and set objectives to deliver results that have a direct impact on