Job Description As a Clinical Relationship Senior Advisor for Commercial, Medicare or Medicaid for the client Anthem, you will lead the strategic documentation and deployment of the plan designs in the clinical space of utilization management and formulary. This role affords you the opportunity to collaborate multiple departments, and lead/support/ train others on the team related to Anthem's needs. You will be seen as a client problem-solver and will bring innovation solutions. You will accomplish this by:
- Building relationships with key client stakeholders through a consultative approach to fully understand clinical components including Formulary Design and UM based on Anthem's benefit plan design needs
- Translating client needs and requirements into operational formats for CVS Health teams such as Clinical Configuration, Benefits Coding and Quality Analysis
- Providing recommendation on how to document requirements for efficiency and accuracy
- Facilitating internal and external meetings and presentations to provide status updates and make decisions relative to the clinical components of the client's plan design/set up
- Support the defining of IT requirements and collaborating with teams to drive the project
- Lead the IT projects supporting the client needs
Your success will be driven by exceeding client satisfaction score targets as well as contributing to reduced service warranty payments to clients. Your healthcare industry knowledge in the areas of Formulary Management, Drug Utilization Management, and Claims Adjudication will also contribute to your success. You will operate in a fast-paced environment with tight deadlines so ability to operate autonomously and make key decisions is imperative. The team will rely on you to lead the discussions, solve the issues and confirm resolution.
Required Qualifications * 7+ years of experience in benefit plan design, account management, or clinically related client-facing field
* 5+ years of expert-level experience in RxClaim/AS400
* Willingness and ability to travel up to 30%
Preferred Qualifications * PBM Industry experience
* Documenting Client Requirements for Utilization Management and Formulary
* Drug File Knowledge
* Experience in providing IT requirements for RxCLAIM
Education * Verifiable High School diploma or GED is required
* Bachelor's degree preferred
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
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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/