A Clinical Pharmacist, Medicare Part D Clinical Operations, is responsible for supporting the Med D Operations Team's clinical strategy to achieve operational excellence and provide consistent clinical decisions for our beneficiaries. A significant portion of the pharmacist's time will be assisting with the queue and calls while interacting directly with prescribers, members, and other CVS Health colleagues. The pharmacist must be able to apply their clinical, regulatory, and systems knowledge to make accurate and timely decisions for our beneficiaries. The pharmacist will review clinical coverage determination and appeal requests as a licensed pharmacist (per state requirements), in accordance with CMS guidance, which states only a pharmacist can deny a coverage determination for Medicare Part D beneficiaries. The ideal candidate must be knowledgeable in all aspects of the coverage determination and appeals processes and assist in meeting clients expectations regarding efficiency, services levels, privacy maintenance and quality decision making. The Clinical Pharmacist will work as part of the team to meet business unit objectives and will be responsible for applying their clinical expertise in their decisions, as well as potentially participating in various clinical projects.
Operational hours for this position are currently 8am to 5pm HST Monday-Friday.
- Active pharmacist license that is in good standing in the state of Hawaii.
- Resident of the state of Hawaii.
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.
* If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 10 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 45 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
* If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 10 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.
- Previous call center experience
- 1+ year of pharmacy experience working with a PBM or Health Plan
- Previous coverage determination and appeals experience
- Experience maintaining focus and meeting goals in a remote, work from home environment
Bachelor's degree in pharmacy (required) or Pharm. D. (preferred)
At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.