Sr Clinical Pharmacist, Quality Initiatives

Job DescriptionThis position reports to the Executive Director of Quality and Accreditation in Medical Affairs and is responsible for a designated primary area of focus and corresponding enterprise quality and accreditation efforts. The individual is accountable for the accreditation needs of both the business and clients. Leads efforts with business process owners to ensure adherence to accrediting body standards and related CVS Health enterprise policies and procedures. Functions independently as the accreditation SME for internal and external customers; provides clinical and strategic guidance on quality and accreditation initiatives such as quality improvement projects (QIPs); and conducts oversight of accreditation-critical business processes including delegated functions.Responsibilities include:1. Manages URAC, NCQA, NABP, ACHC, and/or TJC accreditation audits for CVS Health and provides accreditation audit support for delegated client services. Creates and executes project plans to ensure colleagues, sites, and clients are positioned for successful accreditation reviews. Serves as liaison to internal partners and/or clients and external entities including accrediting agencies. 2. Supports Sales and Account Services, Legal and other impacted business areas as an enterprise accreditation SME. Independently leads accreditation oversight activities per contractual obligations and provides ongoing support as related to accreditation and quality initiatives. Oversees internal business relationships to ensure full compliance to delegated functions critical to client satisfaction and retention.3. Designs and implements processes for ongoing accreditation compliance (e.g., quality dashboard development and maintenance, pharmacy measures data validation and reporting, annual survey submissions, management of grievances and complaints, and conducting vendor oversight). Collaborates with business process owners on internal validation reviews to promptly identify and resolve critical vulnerabilities in accreditation or policy compliance. Provides clinical consultative accreditation support to the enterprise and proactively informs and directs internal business partners so collaborative and fully compliant solutions are identified.4. Recommends, develops, and drives quality-related processes across the organization to improve patient safety, elevate consumer experience and satisfy accreditation requirements. This involves mentoring, coordinating of reporting and analysis, and preparing quality improvement projects for internal and external audiences. Collaborates with teams in Specialty Pharmacy, Mail Service, and/or other applicable clinical business units to identify, develop and support quality improvement efforts. 5. Leads or contributes to department responsibilities such as credentialing, precepting, committee participation, colleague engagement and other Medical Affairs or enterprise-wide initiatives as requested by leadership.This is a remote role, open to candidates anywhere in the United States.Required Qualifications 8 to 10 years pharmacy experience, inclusive of 5+ years clinical pharmacist experience in the managed care PBM environment Consistently demonstrate Heart at Work behaviors: join forces, inspire trust, put people first, create simplicity, and rise to the challenge Strong clinical insight and critical thinking skills: able to ask the right questions, define issues, collect data, establish facts, and draw valid conclusions Act strategically and proactively to meet accreditation and business needs; anticipates potential objections and positively influences others when working across multiple business units to collaboratively reach solutions Able to engage in and lead conversations with internal and external audiences. Comfortable speaking and presenting in a group environment which may include internal and external senior leaders (e.g., clients, accrediting bodies) Strong project management skills: self-motivated with demonstrated ability to manage multiple complex, ongoing projects, coordinate activities with impacted teams, and meet timelines for critical accreditation and/or client deliverables Exceptional written and verbal communication skills. Able to respond skillfully and professionally to customers, accreditors or regulatory agencies with full understanding of the required confidentiality protections for patients and the enterprise Able to identify and implement strategies to improve work efficiency and quality beyond designated focus area (e.g., simplify, streamline, leverage available technologies) Regular and reliable attendance, ability to travel up to 10% when needed (e.g., accreditation audits, client meetings) Registered Pharmacist in good standing in state of residenceCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues 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, religious belief, or other legally recognized reasons that prevents them from being 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 or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications 2 to 3 years quality, project management or accreditation experience Able to work with mathematical concepts for the purpose of assessing and reporting quality performance (including statistical analysis) of clinical programs as well as required accreditation measures Demonstrated business proficiency in various areas including pharmacy operations (Specialty, UM, Mail Service), clinical product offerings, quality improvement processes, and core organizational functions (e.g., Compliance, Privacy, HR, IT/IS, Enterprise Resiliency) Strong PC skills: Office 365 (to include MS Excel) with ability to quickly learn new applications as needed Experience in Adobe ProfessionalEducationDoctor of Pharmacy (PharmD); B.S. Pharmacy with commensurate experience Registered Pharmacist in good standing in state of residenceBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2025-10-04