Job DescriptionThe Lead Pharmacist, Formulary Management is responsible for leading and executing the development, implementation, maintenance, and evaluation of Marketplace (Health Exchanges) template formularies, including formulary-related processes and programs and ensuring full compliance with applicable CMS rules and state specific regulations. Provide oversight of change notification processes for template formularies and drug file maintenance. Provides clinical subject matter expertise and support for internal and external clients.
Other responsibilities include:
1. Prepares formulary submission set ups and updates – includes evaluating drugs for tiering based on cost, clinical classification, quality checking, troubleshooting client issues with submissions, and provision of member documents.
2. Provides business enhancement proposals, contributes to requirement specifications, and performs user acceptance testing on enhancements to Formulary Management Tool and other formulary projects.
3. Provide subject matter expertise and support for internal and external clients. Supports internal departments with clinical and analytical requests concerning formulary (e.g. RFP, Actuary, Marketing, Account Services).
4. Develop and maintain policy and procedure and work instructions.Required Qualifications5+ years experience in a Managed Care environment.
Licensed pharmacist in state of IL.
Strong Clinical skills and knowledge required.
Strong organizational and communication skills and proven ability to lead cross-functional teams in a matrix organization. Able to work across boundaries and locations, have attention to detail, and understand the impacts of their function to the organization, clients, and plan participants.
Knowledge of CMS regulatory requirements and National Library of Medicine database.
Preferred QualificationsGovernment formulary management preferred; Medicaid, Medicare Part D, or Marketplace InsuranceEducationMinimum Bachelors of Science in Pharmacy and be a licensed pharmacist in the state of residence.Business Overview
CVS Health, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units – MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.
CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law. CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW
and EEO IS THE LAW SUPPLEMENT
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance to apply for this job, please contact us by clicking EEO AA CVS Health
CVS Health does not require nor expect that applicants disclose their compensation history during the application, interview, and hiring process.
For inquiries related to the application process or technical issues please contact the Kenexa Helpdesk at 1-855-338-5609. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352. Please note that we only accept resumes via our corporate website: https://jobs.cvshealth.com/