The Director, Utilization Management & Clinical Development will have oversight and lead Medical Affairs pharmacists in the development and maintenance of clinical content for Oncology programs and services provided by CVS Health and Aetna Health Plan. This position will have responsibility for ensuring alignment of clinical strategy across the enterprise and core programs such as Prior Authorization, Step Therapy, Drug Utilization review (DUR), and Formulary Administration. Knowledge of regulations impacting drug coverage programs is required. The ability to interpret state and federal regulations impacting pharmacy practice and drug coverage is essential for ensuring alignment of program content and compliant interventions. The Director will have solid knowledge in PBM practices, medical drug coverage and oncology clinical therapeutics in order to solution and deliver successful clinical strategy across the enterprise.
This role requires the ability to work well in a matrix environment and gather information and resources needed to lead to solution. Strong analytical and problem solving skills are essential along with the ability to forecast impact on workload or other core areas including Operations. The Director will need to strategically allocate work for meeting
Business Overview :
project objectives and inform upper management of status or potential risk to timeline. This position requires knowledge and proficiency in managing complex projects across diverse functional teams and the ability to develop policies/procedures or other supportive documents when needed.
The ability to interact and present strategy, impact and progress to senior leadership is required. Knowledge of the roles of the following stakeholders is essential: Data Analytics, Clinical and Sales Account Management, Trade, Legal, Medical Affairs, IT business owners, Specialty and Non Specialty Product teams and Operations. This position reports to the Sr. Director, Clinical Policy & Strategy
-6+ years of experience working in pharmacy benefit
management (PBM) or managed care organization leading the development and maintenance of clinical content across several programs with experience in Oncology.
-People management experience.
- Knowledge of medical and pharmacy benefit design required.
- Strong Clinician with knowledge and expertise in Oncology treatments and drug therapy.
- Licensed Pharmacist, active and in good standing.
- Pharmacy Practice Residency preferred.
- Board Certified Oncology Pharmacist (BCOP) preferred.
Bachelor Degree in Pharmacy required
Active Pharmacy License (required) in good standing, BCOP Certification (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.
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