Are you looking for more out of your career? If so, Caremark has the perfect prescription for a rewarding and meaningful career. Join our fast-growing, dynamic company where you are encouraged to share your talents, realize your ambitions and reach your career goals, while truly making a difference in the lives of others

Caremark is a one of the nation's leading pharmaceutical services companies, providing comprehensive prescription benefit management services to over 2,000 health plans, including corporations, managed care organizations, insurance companies, unions and government entities. The recent landmark merger of CVS and Caremark created the nation's premier integrated pharmacy services provider. CVS Caremark is a Fortune 20 company that is well positioned to offer end-to-end services, from plan design to prescription fulfillment, as well as the opportunity to improve clinical outcomes and lower overall healthcare costs.

As Caremark continues to grow and diversify, we are proud to offer an outstanding work environment with a variety of exciting opportunities and career paths for dedicated professionals. Caremark is a company that empowers you to succeed.

Supervisor of Specialty Case Review

Position Summary : This position leads the team of clinicians and coordinators that provide review of submitted cases for prospective review of approval of therapy in accordance with health plan approved guidelines. This position manages the team to collaborate with customer service, admissions, pharmacy operations departments as well as health plans and their staff to implement Advanced Guideline Management Specialty Pharmacy Programs. This position is responsible for the implementation process with key clinets implementing managing and participating in client reviews of program operations and results.

Qualifications : -Participate in implementation of new Specialty Pharmacy Programs with employers and health plans. Implementation includes discussion of existing clinical guidelines, individualization of clinical guidelines, processes and procedures to health plan/employer specifics, and review of denial management processes.
- Documentation and validation of client specific processes including communication procedures plan demographics, criteria selection, denial management procedures, and reporting requirements.
- Facilitation of documentation of program agreement with client.
- Collection of appropriate clinical/ medical data needed to perform clinical assessments and/or reviews as per the healthplan/employer agreed criteria.
- Conducts prospective, concurrent, and/or retrospective review of cases using healthplan/employer agreed.
- Documentation of required clinical/ medical data that support case decision as required – electronically and in written format.
- Coordinates timely communication of case decision to physician, healthplan/employer, patient and other healthcare professionals following agreed upon approval & denial management processes.
- Generates, reviews and validates reporting related of program results administered within the Case Review Unit.
- Serves as liaison between the health plan/employers and health care providers related to the specific Specialty Program.
- Collaborates with the Case Review Unit coordinator to process referrals.
- Establishes and maintains communication among Caremark, health plan and employer group staff.
- Participate in quality management activities on an ongoing base.
- Facilitates processing of reporting and health plan specific data requests.
- Maintain professional and technical knowledge of drug and disease-states for the Specialty Pharmacy programs administered within the Case Review Unit.
- Appropriate and timely referral of cases with issues to supervisor to ensure efficient workflow.
- Performs other related projects and duties as assigned.
- Development and ongoing updating of training materials to train new staff on Case Review Unit (CRU) procedures and Specialty Pharmacy.

Education : B.S. degree in Pharmacy and actively licensed RpH; MS in Pharmacy or PharmD desirable

Experience : Five (5) years previous experience in acute care, ambulatory care or home care clinical setting. Previous experience in nursing or pharmacy education or program development. Previous experience program management. Previous experience in public speaking

Caremark offers a competitive salary and comprehensive benefits package that includes company-subsidized medical, dental, and prescription coverage, pay-for-performance bonuses, and a matching 401(k) retirement savings program. Other standard benefits include: life insurance, long-term and short-term disability insurance, flexible spending accounts, tuition reimbursement, employee stock purchase program, supplemental medical coverage, back-up care for your loved ones, generous PTO and holiday time and much more!

Caremark is an Equal Opportunity/Affirmative Action Employer and does not accept unsolicited resumes from agencies.