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We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The Pharmacy Specialty Clinical Development Sr. Manager will be responsible for overseeing the development, maintenance, and execution of Pharmacy Specialty utilization management programs. This will include both the clinical content of the programs as well as the operational actions needed to ensure the programs are implemented correctly. Knowledge of utilization management interventions including prior authorization, step therapy, quantity limits, and Specialty Guideline Management UM processes is required. The leader will feel comfortable partnering in a matrix relationship with colleagues at all levels and teams. This is a hybrid role, based in-office 3 days/wk with the opportunity to work from home the remaining days. Candidate must reside in commutable distance to our Buffalo Grove, IL, Pittsburgh, PA, New York City or Hartford, CT office locations.
Job Responsibility:
Overseeing the development, maintenance, and execution of Pharmacy Specialty utilization management programs
Including both the clinical content of the programs as well as the operational actions needed to ensure the programs are implemented correctly
Requirements:
Licensed pharmacist in good standing in state of residence
5+ years pharmacist experience within PBM environment
3+ years demonstrated people leadership experience within PBM environment
Demonstrated in-depth understanding of and experience with utilization management and formulary, including prior authorization, step therapy, quantity limits, and Traditional drug UM processes
Demonstrated understanding of State and Federal governing rules and regulations
In-depth understanding of Traditional drugs specific to utilization management and formulary
Skill In: Managing teams within a matrixed environment
Partnering across multiple stakeholders and varied levels
Communication and presenting of strategies to Leadership
Excellent written and oral communication with proven ability to distill complex concepts to leaders, colleagues and peers
Office technology and software, including Rx Claim and Medispan
Demonstrated ability to manage multiple complex, ongoing projects
meet timelines for critical deliverables
manage direct reports to achieve team and enterprise goals
work cross-functionally while maintaining and improving inter-departmental relationships