Clinical Pharmacist - FEP/MQA (AZ Licensed)

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.

The RPh Advisor supports the clinical operations of the Member Quality Assurance Commercial and Medicare Part D fraud, waste, and abuse program for a national client. The program's goal is to identify, prevent, and resolve inappropriate drug utilization, identify negative trends, refer potentially fraudulent activity to the MQA investigators, remain compliant with the Drug Management Program for CMS.

The RPh Advisor works with a diverse departmental staff which includes Professional Investigators, Data Analysts, and Clinical Assistants. Responsibilities include clinical review of plan member profiles for FWA, managing the Overutilization Taper program, submission of specific cases to vendor for External Peer Review (EPR), assistance with program and system enhancements, securing client satisfaction and retention, and working cross functionally with client and internal partners to help identify and resolve FWA issues. The RPh communicates directly with the client on a regular basis regarding status of program. 

Candidate must be a licensed Pharmacist in the state of Arizona with the ability to work a hybrid (1 day/wk in office) role based out of the Phoenix, AZ office, with the ability to work remotely the remaining days.

This position requires excellent people skills and the ability to be innovative, proactive, resolve problems, exercise good judgement, and contribute to a team environment.  Exceptional written and oral communications skills are needed to discuss clinical information with patients, providers, and team members.

1. Excellent verbal and written communication skills

2. Well organized with the ability to effectively prioritize work

3. Customer focused

4. Ownership and results driven

5. Attention to detail

6. Proficient use Microsoft Office applications, e.g. Outlook, Excel, Word

7. Ability to effectively work within a team

8. Flexible in adapting to change

9. Ability to effectively plan, prioritize, organize time and workload

10. Skilled in identifying and solving issues and recommending process improvements

11. Ability to work successfully in a deadline-oriented environment

12. Must be able to communicate in a professional demeanor and maintain high confidentiality standards

Previous experience supporting federal and/or state government clients.

Previous experience working on fraud, waste and abuse issues for clients.

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.