Clinical Pharmacist, Medicare

es, 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.

This is a hybrid role, based out of either our Buffalo Grove, IL or Pittsburgh, PA office locations. Colleague would work 3 days per week in office, with the ability to work remotely the other 2 days. Must reside in commutable distance to Buffalo Grove, IL or Pittsburgh, PA.For this role you will need Minimum Requirements

• 3+ years pharmacist experience in the managed care space

• Demonstrated Medicare Part D utilization management experience

• Registered Pharmacist (RPh) in good standing with no restrictions

• 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

Anticipated Weekly Hours
40Time Type
Full timePay Range

The typical pay range for this role is:$118,000.00 - $206,250.00This 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.Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefitsWe anticipate the application window for this opening will close on: 04/28/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.