Job Information
CVS Health Clinical Pharmacist, Medicare in Pittsburgh, Pennsylvania
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
A Brief Overview
Applies highly developed skills to create and maintain clinical content for drugs covered under the pharmacy and medical benefit, working with business partners and product teams to identify, develop, and monitor the impact of programs on supporting drug coverage through the pharmacy and medical benefit.
What you will do
Evaluates, researches and develops evidence-based clinical content related to drugs, including drug profiles, therapeutic guidelines, formulary management strategies, and coverage criteria for Medicare Part D.
Collaborates with the formulary management team to assess and recommend drug inclusion/exclusion based on clinical evidence, safety, efficacy, and cost-effectiveness, ensuring alignment with clinical content..
Conducts thorough clinical assessments of new drugs, drug utilization trends, and emerging therapeutic classes to provide informed recommendations for inclusion in formularies and benefit tiers.
Creates and refines coverage criteria and prior authorization guidelines to ensure appropriate utilization of medications, supporting cost-effective and evidence-based prescribing.
Works closely with business partners, including product teams, medical directors, actuarial teams, and legal/compliance departments, Medicare teams, to align clinical strategies with Medicare business goals and ensure compliance with regulatory requirements.
Monitors the impact of clinical programs and interventions on drug utilization, patient outcomes, and cost savings. Analyzes data to identify trends and opportunities for continuous improvement.
Stays current with evolving healthcare policies, Medicare regulations, and market dynamics that impact drug coverage, reimbursement, and access and provides insights to inform strategic decision-making.
Contributes to quality improvement initiatives by participating in clinical audits, quality assurance activities, and performance assessments to ensure the accuracy and consistency of clinical content.
Develops educational materials, such as drug monographs, clinical summaries, and training materials, to assist internal teams, healthcare providers, and customers in understanding clinical aspects of covered drugs.
For this role you will need Minimum Requirements
3+ years work experience
Previous Medicare Part D utilization management work experience
Registered Pharmacist (RPh) in good standing with no restrictions required.
Mastery of problem solving and decision making skills.
Mastery of collaboration and teamwork
Mastery of growth mindset (agility and developing yourself and others) skills
Mastery of execution and delivery (planning, delivering, and supporting) skills
Ability to consider the relative costs and benefits of potential actions to choose the most appropriate option.
Ability to function in clinical setting with diverse cultural dynamics of clinical staff and patients.
Mastery knowledge of phases of care transitions and resources available for patients.
Education
- BS in Pharmacy or PharmD
Pay Range
The typical pay range for this role is:
$118,000.00 - $206,250.00
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 Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)
We anticipate the application window for this opening will close on: 02/11/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.