Description

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Position Summary

The Academic Detailer/Clinical Advisor is a unique and high-impact pharmacist role combining clinical expertise, Medicare knowledge, data insights, and provider-facing communication skills. In this role, you will partner directly with a Medicare Advantage Health Plan to optimize formulary utilization, guide providers through preferred product selection, and support members in receiving the safest, most cost-effective therapies.

You will serve as a front-line clinical expert-educating prescribers, influencing prescribing behavior, identifying cost and quality opportunities, and ensuring the drug benefit is delivered in a clinically sound and financially responsible manner. This includes leveraging data, engaging directly with physicians, and aligning PBM and health plan strategies to drive superior outcomes.

This role is ideal for a pharmacist with PBM or health plan experience, strong knowledge of Medicare Part D rules, and exceptional communication and analytical skills.

This is a remote role, open to qualified candidates within the United States. Candidate must be willing and able to travel up to 40% of the time to meet business needs.

Key Responsibilities

Clinical Strategy & Formulary Optimization

• Serve as the clinical subject matter expert for Medicare Part D formulary, utilization management, and preferred product strategy.
• Analyze drug utilization, trends, prescriber behavior, and savings opportunities at the plan, provider, and member level.
• Identify and implement strategies to drive preferred product adoption, biosimilar conversion, generic utilization, and gross-to-net optimization.
• Translate complex rebate, pricing, and utilization concepts into clear recommendations for both providers and health plan partners.

Provider Engagement & Academic Detailing

• Conduct direct outreach to prescribers via phone, virtual sessions, and in-person visits to influence safe, cost-effective prescribing.
• Deliver concise clinical messages on preferred alternatives, formulary pathways, safety considerations, and affordability.
• Educate providers on coverage determination processes, PA submissions, documentation requirements, and Medicare rules.
• Build strong relationships with prescribers, provider groups, and health plan clinical teams to reduce avoidable denials and improve member experience.

Medicare Part D & Utilization Management Expertise

• Apply expert-level understanding of CMS guidelines, HPMS memos transition rules, tiering exceptions, and benefit requirements.
• Support providers in navigating Coverage Determinations (CDs), Prior Authorizations (PAs), redeterminations, and appeals.
• Assist in the identification and correction of common PA submission patterns that lead to denials.

Data Interpretation & Reporting

• Partner with analytics teams to develop and deliver monthly, quarterly, and annual clinical reporting for the Health Plan.
• Use internal reporting tools (e.g., analytics dashboards, claims systems) to produce actionable insights.
• Present clinical and financial outcomes to health plan and PBM leadership, showcasing progress and impact.

Cross-Functional Collaboration

• Work closely with PBM stakeholders, health plan pharmacy leadership, FWA teams, formulary operations, specialty teams, and network partners.
• Identify opportunities to reduce fraud, waste, and abuse and improve overall drug program performance.
• Participate in strategy meetings, benefit reviews, provider initiatives, and clinical program deployment.

Leadership & Representation

• Represent Caremark and the Health Plan in provider meetings, care team discussions, and cross-functional initiatives.
• Support implementation of new clinical programs, benefit changes, and formulary updates.
• Travel for onsite provider visits, health plan meetings, and targeted field engagement as required (up to 40%).

Required Qualifications

• Active, unrestricted pharmacist licensure
• 5+ years of clinical experience, ideally including at least 1 year in a PBM, Health Plan, or Managed Care residency program.
• Strong demonstrated understanding of Medicare Part D benefit design, UM criteria, coverage determinations, and formulary management.
• Exceptional oral, written, and interpersonal communication skills.
• Proficiency in Microsoft tools and comfort working with data, dashboards, and reporting systems.
• Ability to travel up to 40% for provider engagement and onsite Health Plan needs.

Preferred Qualifications

• 3+ years direct experience in PBM, Health Plan, or Managed Care pharmacy in a client-facing role.
• Experience influencing prescribers, conducting academic detailing, or leading provider education initiatives.
• Strong analytical skills with ability to explain net cost, rebates, preferred product strategy, and clinical impact in simple terms.
• Ability to manage multiple high-visibility projects simultaneously and work autonomously.
• Familiarity with AMCP frameworks; AMCP Fundamentals of Managed Care Pharmacy Certificate strongly preferred.
• Comfort preparing provider-facing materials, clinical talking points, or formulary change communications.

Education

BS in Pharmacy or PharmD

Anticipated Weekly Hours
40

Time Type
Full time

Pay Range

The typical pay range for this role is:

$110,925.00 - $228,800.00

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.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 05/11/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.