Clinical Pharmacist - FEP/MQA

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Position Summary

The RPh Advisor supports the clinical operations of the Member Quality Assurance fraud, waste, and abuse program for the Federal Employee Program (FEP). The program's goal is to identify, prevent, and resolve inappropriate drug utilization, identify negative trends and refer potentially fraudulent activity to the MQA investigator and/or client Special Investigations Unit (SIU) for further analysis.

The RPh Advisor works with a diverse departmental staff which includes Professional Investigators, Data Analysts, and Clinical Assistants. Responsibilities include clinical review of plan member profiles for FWA, managing the Overutilization Taper program, submission of specific cases to vendor for External Peer Review (EPR), assistance with program and system enhancements, securing client satisfaction and retention, and working cross functionally with client and internal partners to help identify and resolve FWA issues. The RPh communicates directly with the client on a regular basis regarding status of program. 

Required Qualifications

This position requires excellent people skills and the ability to be innovative, proactive, resolve problems, exercise good judgement, and contribute to a team environment.  Exceptional written and oral communications skills are needed to discuss clinical information with patients, providers, and team members.

1. Excellent verbal and written communication skills

2. Well organized with the ability to effectively prioritize work

3. Customer focused

4. Ownership and results driven

5. Attention to detail

6. Proficient use Microsoft Office applications, e.g. Outlook, Excel, Word

7. Ability to effectively work within a team

8. Flexible in adapting to change

9. Ability to effectively plan, prioritize, organize time and workload

10. Skilled in identifying and solving issues and recommending process improvements

11. Ability to work successfully in a deadline-oriented environment

12. Must be able to communicate in a professional demeanor and maintain high confidentiality standards

Candidate must be a licensed Pharmacist in the state of Arizona with the ability to work a hybrid (3 days/wk in office) role based out of the Phoenix, AZ office.

Preferred Qualifications:

Previous experience supporting federal and/or state government clients.

Previous experience working on fraud, waste and abuse issues for clients.

Education
BS Pharmacy required

Pharm D preferred

Licensed Pharmacist in the State of AZ

Pay Range

The typical pay range for this role is:

$80,340.00 - $173,000.00

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