RPh Advisor

Job DescriptionAs the Clinical Services Pharmacist you will be responsible for reviewing clinical criteria for implementation, maintaining compliance with ERISA, Medicare, Medicaid, and client specific requirements. As the Pharmacist you will become knowledgeable in all aspects of the PA and Appeals process and assist in meeting clients expectations regarding efficiency, service levels, privacy maintenance and quality of decision-making. Work as part of a team to meet business unit objectives. Additionally, you will be responsible for reviewing implementation requests, respond to clinical program implementation and maintenance inquiries, as well as completing data analysis and various clinical projects related to configuration in the prior authorization and appeals system. The position will also include serving as a clinical resource for the department.Pay RangeThe typical pay range for this role is:Minimum: 74,600Maximum: 160,700Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required QualificationsActive state licensed pharmacist with current license to practice with no restriction;1+ years pharmacy experience,1+ years experience with utilization management programs.COVID 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 Experience in Pharmacy Benefits Management Strong Microsoft Office skills. Ability to balance clinical knowledge and customer service demands Managed care experienceExperience within the Case Review Unit (CRU) or Clinical Operations preferred Experience with Specialty Drug formularies and/or clinical programsEducationActive state licensed pharmacist (B.S. or Pharm D) with current license to practice with no restrictionsBusiness 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: 2025-11-15