Clinical Pharmacist, UM Development Regulatory

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position Summary
The Clinical Pharmacist, UM Development Regulatory is a key contributor to ensuring pharmacy benefit programs comply with federal and state regulations, particularly those related to the Department of Insurance (DOI) and mental health parity laws such as the Mental Health Parity and Addiction Equity Act (MHPAEA). This role supports the development and maintenance of evidence-based utilization management (UM) criteria and serves as a subject matter expert in regulatory pharmacy practices, with a focus on equitable access to care for individuals with mental health and substance use disorders. The position will support Department of Insurance audits, PBM market conduct examinations, CMS audits, and internal regulatory reviews and evaluations. Cross-functional collaboration with internal and external stakeholders will be required.This is a hybrid role based out of our Buffalo Grove, IL or Pittsburgh, PA office locations, working 3 days/week in office and 2 days/week from home.

Required Qualifications

• PharmD or equivalent clinical pharmacy degree.
• Active pharmacist license in good standing.
• 3-5 years of experience in regulatory pharmacy, utilization management, or PBM operations.
• 3+ years of managed care experience.
• 3+ years of relevant UM or prior authorization experience.
• Strong understanding of MHPAEA, CMS regulations, and market conduct exam processes.
• Demonstrated understanding of UM interventions (prior authorization, step therapy, quantity limits, formulary exceptions).
• Proven proficiency in literature search and evidence-based medicine analysis.
• Experience with internal audits, external regulatory reviews, and market conduct examinations.
• Excellent written and oral communication skills, with the ability to distill complex concepts for leadership.
• Project and process management experience.
• Ability to understand and optimize complex workflow processes.
• Skilled in MS Office applications (Word, Excel, Access, PowerPoint).

Preferred Qualifications

• Experience supporting audits and regulatory reviews in a PBM or managed care setting.
• Familiarity with mental health and substance use disorder treatment guidelines.
• Ability to manage complex projects and cross-functional initiatives.
• Acumen specific to Specialty Pharmacy, Utilization Management, Formulary Management.
• Knowledge of Regulatory Rules and Requirements.

Education

• BS in Pharmacy or PharmD required

Anticipated Weekly Hours
40Time Type
Full timePay Range

The typical pay range for this role is:$129,800.00 - $206,250.00This 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 peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefitsWe anticipate the application window for this opening will close on: 09/08/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Client-provided location(s): Pittsburgh, PA

Job ID: CVS-R0680763_1001

Employment Type: FULL_TIME

Posted: 2025-08-22T19:47:40