Clinical Pharmacist - AMA Dual

Position SummaryThe Clinical Pharmacist - AMA Dual will be a multi-dimensional position; the primary areas of responsibility will include the following:Complete Clinical Reviews and provide a determination of Medicare-Medicaid Coverage Determination/Redetermination, Medical Review, Global Exception etc. by reviewing all requests which are not clearly approvable based on specified criteria (algorithms).Responsible for support and input to clinical programs such as: Health Management (IDT), Drug Utilization Review, Formulary development, and Prior Authorization programs to encourage appropriate, high quality, cost effective drug therapy; and to identify opportunities for improvement in efficiency, accuracy, and appropriateness of the programs in place.Continually monitor the quality and efficiency of the Prior Authorization process including coverage criteria, denial language, and communication with prescribers and members. Provide recommendations to physicians to improve medication regimens as appropriate.Provide input to clinical content of new programs and for maintenance of existing programs.Complete all annual NCQA, Aetna required and Quarterly IRR training requirements.Responsible for supporting / providing clinical expertise related to formulary decisions made by the Pharmacy and Therapeutics committee.Assists Member Services and other internal customers in responding to and resolving pharmacy-related inquiries from members (NCQA Requirement).Maintain open lines of communication with other functional areas/departments.Responsible for staying current with clinical literature and guidelines and relaying those to the program development core teams.Remote role open to qualified candidates within the United States. Team hours are M-F, 6:30am-6pm AZ time. Colleague will be scheduled a regular shift during this timeframe once training is complete. On-call or weekend hours may be required post-training to meet business needs, current rotation requirement is every 5th weekend.Required QualificationsDemonstrated proficiency in Microsoft Excel, Word, Outlook, and SharePointSuperior written and verbal communication skills1+ year managed care pharmacist experience (Medicaid and/or Medicare) and/or completion of PGY1 managed care residency1+ year of previous clinical pharmacy experienceDemonstrated knowledge of clinical program components, formulary designs, and prescription benefit trendsActive Registered Pharmacist license is required in State of ResidencePreferred Qualifications3+ years of experience working as a licensed Pharmacist3+ years managed care experience is highly desirable, but not requiredRxClaim experienceProven success in a fast-paced, remote working environmentEducationDoctor of Pharmacy degree (Pharm.D.)Anticipated Weekly Hours40Time TypeFull timePay Range$106,200.00 - $225,000.00The typical pay range for this role is: $106,200.00 - $225,000.00. 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.BenefitsThis full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.J-18808-Ljbffr