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Clinical Operations MTM Advisor - Senior

at CVS Health

Posted: 7/24/2020
Job Reference #: 1319203BR
Keywords: management

Job Description

Job Description
Do you want to make an impact on a team and be a health care innovator? The Clinical Operations Medication Therapy Management (MTM) Advisor - Senior is a vital contributor to the development, implementation, maintenance and overall management of the Caremark MTM program. You will be responsible for ensuring compliance with CMS regulations, meeting client expectations and ensuring positive member outcomes in relationship to the following:

- Development of annual Medicare Part D MTM program descriptions
- Design and maintenance of clinical components of standard Caremark MTM program offerings for Medicaid and Commercial lines of business
- Leading cross-functional implementation of regulatory requirements with internal business partners and external MTM vendors

The Clinical Operations MTM Advisor - Senior will also ensure the successful execution of clinical operations including:

- Ongoing maintenance of the Targeted Medication Review (TMR) intervention library based on clinical guidelines, program updates and other defined priorities which contribute to the program’s success
- Evaluation and maintenance of drug lists used to facilitate disease state-specific targeting for member enrollment into the MTM program
- Conducting oversight of MTM program activities delegated to MTM vendors, including ensuring accuracy and appropriateness of clinical interventions delivered to members, with a strong focus on continuous quality improvement
- Providing clinical support for all audit activities (internal, client mock, and CMS audits) and leading cross-functional remediation of audit findings as applicable
- Leading execution of internal project plans to ensure timely completion of all tasks related to the MTM program. Facilitating weekly team status calls and ensuring that product milestones are achieved
- Collaborating with internal and external business partners to identify and implement innovative member engagement strategies and other clinical initiatives to improve program performance and operational efficiencies while ensuring member and client satisfaction
- Leading all client set up and configuration activities with external vendor to support annual program updates
- Partnering with internal business partners and external vendors to execute new client implementations, including participating in discussions with clients to gather program requirements as needed
- Analyzing trends and developing action plans to drive desired outcomes
- Gaining the trust and confidence of internal and external business partners
- Building strong cross-functional relationships across the Enterprise and with external business partners to enable long-term continued program growth and client retention

This position has the ability to work remotely from home within the U.S. Relocation is not required. Must have ability to travel occasionally.

Required Qualifications
Minimum 1 year of experience in the following:
* Project and/or process management
* Leading cross-functional teams to implement strategies and solutions to gain efficiencies
* Intermediate proficiency utilizing Microsoft Office suite programs

Preferred Qualifications
* Doctorate (licensed BS Pharmacy or PharmD)
Successful completion of a residency program focused in Managed Care and/or Medicare
* Knowledge of MTM program requirements (including fundamental Regulatory requirements) and objectives for Medicare, Medicaid, and commercial populations
* Proven success utilizing communication skills to lead meetings, engage stakeholders, and manage expectations and deadlines
* Experience analyzing trends and developing action plans to drive desired outcomes
* Knowledge of drug resource tools and ability to use clinical resources/guidelines to influence program design and strategy

Education
Bachelor's Degree

Business Overview
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.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!