Clinical Director - FEP/MTM

Bring your heart to CVS Health. Every 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.

Position Summary

As the Clinical Operations Director, you will manage the Blue Cross Blue Shield Association Service Benefit Plan - Federal Employee Program (FEP) Patient-Centered Care program (PCare). PCare is a URAC accredited Medication Therapy Management program that is dedicated to serving the FEP population. Additionally, the clinical director is responsible for delegated accreditation standards to support BCBS FEP and the BCBS plans.

Duties include managing a large complex operational department, quarterly client meetings, multi-layered personnel management and developing/maintaining internal and external relationships. As the director, you will support clinical program development and design recommendations, compliance with contract requirements, and operational efficiencies/quality improvement. You will also have budget oversight and fiscal responsibility for a large department. This position interfaces with one of our largest clients; account management, senior management, and operational departments and work cross functionally with other clinical programs including fraud and abuse and prior authorization. This position will have budget development and management responsibility. In addition, the director will lead the hiring, development and refinement efforts of this unique department. The director will work with internal departments including: IT for systems creation and enhancement, the FEP Account team for client direction, FEP specific CSUs and FEP operational sites. Finally, the director will be responsible for communicating program activity to the FEP Directors Office.

Required Qualifications

In addition to 5-8 years of demonstrated managed care experience, the candidate must also have:

1. Demonstrated experience dealing with large health plans
2. Demonstrated experience managing a group of individuals including pharmacists
3. Call center experience
4. Excellent written and verbal communication skills
5. Experience with Project Management
6. Business Application Management experience
7. Business Analysis experience
8. Active, unrestricted Arizona pharmacist licensure

Essential Functions

1. Regular and predictable attendance
2. Colleague will be required to work mandatory overtime/extended work week when needed
3. Colleague will be required to travel when needed, up to 10%
4. Colleague must be able to communicate effectively in both written and verbal formats and have exceptional clinical skills
5. Colleague must be able to multi-task

Preferred Qualifications

1. 8-10 years managed care experience
2. Med D MTM experience
3. EPIC experience
4. Large client management experience

Education

B.S. Pharmacy (PharmD preferred)

Arizona licensed pharmacist in good standing

Pay Range

The typical pay range for this role is:

$123,857.50 - $266,800.00

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. This position also includes an award target in the company’s equity award program.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long-term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

Application Information

We anticipate the application window for this opening will close on: 03/20/2024

COVID-19 Vaccination Requirement

CVS 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.

Equal Employment Opportunity

CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through . If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.