Job DescriptionThe Medical Affairs division provides clinical business support to the entire enterprise and provides clinical oversight and guidance for CVS Caremark clinical programs, PBM Clinical Quality activities, internal medical support for P&T process, formulary development, generic information services, pipeline activities and provision of clinical leadership and support to various internal departments (e.g., specialty pharmacy services, clinical product development, Enterprise Analytics, Compliance, Legal, Accreditation). This position will report to the Senior Medical Director in Medical Affairs and is responsible for clinical support and consultative activities across the PBM.
This position may provide additional clinical support to Key Clients as assigned, such as FEP. This position also supports internal physician administered UM activity (prior authorization and appeals) and external physician support (physician inquiries) as required. The position of Medical Director for CVS Caremark is a clinical position within the Medical Affairs Division, responsible for clinical support and consultative activities across the PBM and Enterprise. Each Medical Director is expected to interact with other Senior Directors and VPs within Clinical Affairs and across the full enterprise. Medical Directors in CVS Caremark are expected to model the highest levels of clinical integrity, knowledge and cross functional thinking and decision making. They represent the prescriber as a stakeholder across the enterprise’s decisions and planning.
• Each Director is responsible for oversight of a portion of CVS Caremark‘s clinical programs and commercial client program support. Will share in reviews of utilization management (PA) criteria and clinical policy revisions/reviews.
• As experience/skills dictate, each Director may be assigned to attend or chair certain committees involved with development and maintenance of formularies, clinical programs and clinical quality within the PBM.
• Directors will spend a portion of most days completing assigned medication utilization reviews (PA) and/or medical necessity appeals for commercial clients, governmental (Medicare/Medicaid) programs and individual client requested coverage determinations or appeals when appropriate. Medical Directors will participate in inter-rater review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to one business segment (i.e., Medicare clients), each director will become sufficiently skilled in various UM programs to support other segments (including commercial and Medicaid) on evening and weekend coverage.
• Will support the Division’s responsibilities to provide peer to peer phone call support to physicians/prescribers who call the company with specific and general questions about our clinical programs, communications and utilization review decisions. After a period of orientation, will share an equal portion of physician callbacks on a monthly basis.
• Will perform a share of special clinical investigations and research as requested by the Senior Medical Director, Medical Affairs. These projects can include brief reviews of published literature around specific pharmaceutical questions or more in-depth projects requiring collaboration with pharmacists within Medical Affairs and in business units outside of the Division.
Required Qualifications* Possess an unrestricted active license to practice medicine issued by the State Board of Licensure or the State Board of Osteopathic Examiners
* Required annual Continuing Medical Education (CME) up to date and must remain current in medical and management areas during employment
* Have adequate clinical experience in the practice of medicine outside of formal residency program
* Demonstrated experience in clinical outcomes, working knowledge of medical statistics, regulatory agencies, and analytic programs
* Ability to work with teams of pharmacists to develop clinical programs/guidance for physicians and other prescribers
* Management skills to meet the multiple time limited organizational goals
* Knowledge of PBM environment, quality improvement and UM practices in a managed care environment (or desire to engage in rapid learning thereof)
* Knowledge of regulatory and accreditation agencies and requirements
* Able to manage multiple priorities and deadlines
* Able to manage difficult peer situations arising from UM reviews
* Excellent verbal, written, interpersonal and presentation skills
* Strong research and information retrieval skills
* Strong experience in drug information and clinical study design interpretation
* Strong knowledge of and proficiency with multiple Microsoft applications. (e.g., MS Word, Excel, and PowerPoint minimum)
* Understanding of the Project management process and proven experience in staff and budget management is strongly desirable
Preferred Qualifications* Combination of five years of management and/or clinical experience in a managed care environment
and health administration, including adequate clinical experience in the practice of medicine and working with health care professionals at different levels as a team player (e.g., RNs, PharmDs, etc.)
* Equivalent combination of education and experience will be evaluated
* Master’s Degree in Public Health Administration or MBA preferred, UM/QA certification desired
Education* Must be graduate of an accredited Medical School and Residency Program
* ABMS or AOA Board Certified in a recognized medical specialty, preferably in a Primary Care field (Internal medicine, Family Medicine) or a specialty within Internal Medicine such as Cardiology or Endocrinology.
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
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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/