Senior Clinical Pharmacist, Medical Affairs - Clinical Innovation and Regulatory Strategy at CVS Health

Buffalo Grove, Illinois, United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, PharmaceuticalsIndustries

Requirements

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 experience (unspecified, based on description)
Candidate must reside in commutable distance to Pittsburgh, PA, Buffalo Grove, IL, or Scottsdale, AZ office locations

Responsibilities

Identify opportunities and best practices in the development and maintenance of programs supported by Medical Affairs
Drive the regulatory strategy of UM programs and support regulatory compliance activities for Medical Affairs, including accountability for utilization management (UM), formulary development, regulatory audits, and clinical analytics
Work cross-functionally to ensure clinical accuracy, adherence to ethical practices, and compliance with MHPAEA, CMS, DOI regulations
Demonstrate knowledge of pharmacy benefit management programs and services across multiple channels
Lead contributions supporting standard and customized clinical services for CVS Caremark products
Develop, manage, and evaluate 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
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
Support analytics activities and collaborations to measure and communicate the value of clinical programs
Analyze large datasets to identify trends and 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
Represent Medical Affairs in cross-functional forums, key initiatives, projects, and planning sessions
Comprehend clinical vision and communicate direction within and outside of Medical Affairs
Engage stakeholders and define contributions to make clinical program development successful

Skills

Clinical Programs

Regulatory Strategy

Utilization Management

Formulary Development

Regulatory Compliance

MHPAEA

CMS

DOI Regulations

Pharmacy Benefit Management

Clinical Analytics

Medical Affairs

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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