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 Health Plan Clinical Advisor is a client facing role that manages the clinical relationship by influencing multiple key decision makers at a health plan. These include the health plan’s pharmacy support team, pharmacists, medical directors, CMO as well as other senior health plan leaders.
The Health Plan Clinical Advisor should be able to manage at least 2 and up to 4 market segments for any particular client (Medicare, Medicaid, Exchange, or Commercial).
The Health Plan Clinical Advisor is responsible for proactively managing the clinical relationship alongside the business lead (SAE/SAD) to understand and drive each of their client’s priorities, financial targets, clinical goals and other commitments to their leadership.
The Health Plan Clinical Advisor will analyze and evaluate the client’s data and competitive marketplace conditions and forces to develop and execute a comprehensive business plan that supports the client’s short- and long-term profitability and growth strategies. Key components being eliminating waste, reducing inefficiency and maximizing impact to manage chronic disease. This includes:
- Collaborating with clients on analysis of their key marketplace competitors and those products and services.
- Consulting with and recommending standard and custom formulary options and utilization management edits.
- Collaborating with internal partners to develop or modify custom programs or formularies that meet the unique needs of health plan clients.
- Collaborating with CVSH trade partners on formulary strategies to maximize rebate value and drives lowest net cost.
- Consulting with and recommending utilization management programs or other clinical programs to a client.
- Consulting with and recommending specialty drug strategy options.
- Consulting with ANCS, to utilize clinical and financial reports to evaluate current benefit design and provide recommendations to clients on any opportunities.
- Consulting and Influence clients on current drugs trends, drug pipeline, as well as proactive monitoring of FWA trends.
- Consulting and influencing clients on a regular basis, developing a trusted consultative partnership that drives client loyalty and fulfills both clients commitments and CVSH goals.
- Conducting Provider and Member outreach as needed for client communications.
The Health Plan Clinical Advisor will consult with and advise the Clinical Benefits Pharmacist, and or other members of the Benefits and Operations teams so that those teams can timely and accurately implement a client’s requirements.
The Health Plan Clinical Advisor will collaborate with CVSH internal partners to ensure compliance to any federal, state or local regulatory requirements that impact formulary, UM and or clinical programs and consult with any clients on the impact that such requirements might have on their plan.
The Health Plan Clinical Advisor is accountable for ensuring that CVSH meets or exceeds any health plan client value targets each year and is responsible for proactively collaborating with business leads to identify client value and then provide consultative advice and follow up with the client on such recommendations. Consultative advice may include recommendations for program pilots, modification to existing CVSH programs to support the unique needs of the health plan segment and marketplace and/or how CVSH as an enterprise can support health plans through our open source model.
The Health Plan Clinical Advisor is responsible for ensuring they meet or exceed their personal and departmental client satisfaction scores target each year.
This position can be located in a CVSH Corporate Hub or can work remotely/work from home within the United States. Clinical Advisors must have the ability and willingness to travel up to 50% of the time.
Required Qualifications
- 3+ years of managed care Pharmacist experience and/or 1 year of Managed Care Residency program.
- Active pharmacist license that is in good standing.
- Demonstrated experience in a client-facing role within the managed care environment
- Demonstrated understanding of and experience with utilization management trends and programs within the managed care environment
- Highly organized, detail oriented, proficient analytical ability with effective listening & presentation skills are required.
Preferred Qualifications
- 3-5 years of experience supporting Pharmacy Benefit Management (PBM) clients or within a health plan.
- Experience in all market segments (Medicare, Medicaid, Exchange and Commercial)
- Expertise in Utilization Management, Formulary Management and Clinical Products
- Proven leadership skills.
- Strong business acumen.
- Commitment to client service and relationship building.
- Experience implementing template and/or customized clinical programs.
- Knowledge of PBM adjudication engine and other systems leveraged in support of clients.
- AMCP Fundamentals of Managed Care Pharmacy Certificate or similar professional advancement.
Education
BS in Pharmacy or PharmD
Active, unrestricted pharmacist licensure in at least 1 state
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$110,925.00 - $249,600.00This 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 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.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- 3 or more years of managed care pharmacist experience or 1 year of a managed care residency program
- Active pharmacist license in good standing
- Active, unrestricted pharmacist licensure in at least one state
- Demonstrated experience in a client-facing managed care role
- Experience with utilization management trends and programs in managed care
- Strong organization, attention to detail, analytical ability, listening, and presentation skills
- BS in Pharmacy or PharmD
- 3 to 5 years of experience supporting PBM clients or working within a health plan
- Experience across Medicare, Medicaid, Exchange, and Commercial market segments
- Expertise in utilization management, formulary management, and clinical products
- Leadership skills and strong business acumen
- Experience implementing template or customized clinical programs
- Knowledge of PBM adjudication engines and related client-support systems
- AMCP Fundamentals of Managed Care Pharmacy Certificate or similar professional advancement
CVS Health Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about CVS Health and has not been reviewed or approved by CVS Health.
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Healthcare Strength — Health coverage includes medical, dental, and vision with HSA-eligible options, free preventive care, virtual care, and access to MinuteClinic services. Mental-health resources such as counseling support are emphasized, and coverage is often considered solid for full-time colleagues.
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Retirement Support — A dollar-for-dollar 401(k) match up to 5% after one year and an Employee Stock Purchase Plan are consistently highlighted in Total Rewards materials. Feedback suggests retirement programs are a meaningful strength within the overall package.
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Wellbeing & Lifestyle Benefits — Wellbeing offerings include up to 20 no-cost counseling sessions per issue, backup care, tuition assistance, and substantial in-store discounts, alongside broader wellness tools. These everyday perks expand value beyond base pay and can be especially meaningful for full-time schedules.
CVS Health Insights
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
