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 Clinical Operations Advisor is a client facing role that collaborates with Health Plan Clinical Advisor to understand the client’s clinical strategy and roadmap to create a clinical operations plan. The Clinical Operations Advisor works with the Benefit Relationship Manager and client to facilitate gathering formulary and utilization management requirements and designs the drug level setup for projects on the operations plan while ensuring compliance to internal best practice and federal and state guidelines.
The Clinical Operations Advisor designs the clinical setups using Caremark technology solutions and supports the coding teams in the loading of clinical data into the adjudication system. The Clinical Operations Advisor partners with account team members to document clinical design best practices, provide input to streamline processes, and identify opportunities to improve the efficiency and accuracy of clinical setups. The Clinical Operations Advisor supports internal and client audits of clinical setups within adjudication systems, which includes verifying the client approved requirements and design.
The Clinical Operations Advisor should be able to manage multiple health plan clients across multiple lines of business including Medicare, Medicaid, Exchange, and Commercial. This is a remote role, open to qualified candidates within the Central or Eastern time zones of the United States. Clinical Operations Advisor must have the ability to travel up to 5% of the time.
Required Qualifications
Active Registered Pharmacist license in state of residence
2-3+ years prior relevant work experience as a pharmacist in managed care (Pharmacy Benefit Management) environment
Demonstrated understanding of CVSH clinical portfolio, marketplace segments dynamics (Medicare, Medicaid, Exchange, and or Commercial) and industry trends
Demonstrated experience with Utilization Management and Formulary Management in managed care environment
Demonstrated experience in a client-facing role within PBM environment
Proficiency with Microsoft applications - Excel, PowerPoint, Word, Outlook, Access, Teams
Demonstrated experience with CVSH internal reporting and analytic tools for client management or industry equivalent
Excellent written and verbal communication skills both virtually and in person
Ability to analyze large volume of clinical data and organize this data for downstream teams such as configuration and testing teams
Attention to detail to ensure data fidelity and data integrity is well understood including the business rules for data transformation
Ability to work on multiple projects, prioritize, and resolve complex problems
Effectively work independently without daily supervision
Impact and influence others
Drive results and deliver on goals and commitments
Facilitate cross functional communication and collaboration
Consult and influence internal stakeholders and client contacts
Preferred Qualifications
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
Experience implementing template and/or customized clinical programs
Knowledge of PBM adjudication engine and other systems leveraged in support of clients
RxClaim experience
Proven leadership skills
Commitment to client service and relationship building
Education
Bachelor Degree in Pharmacy required, PharmD preferred
Active, unrestricted pharmacist licensure required
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$110,925.00 - $228,800.00This 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
- Active Registered Pharmacist license in state of residence
- 2-3+ years prior relevant work experience as a pharmacist in managed care
- Understanding of CVSH clinical portfolio and industry trends
- Experience with Utilization Management and Formulary Management
- Experience in a client-facing role within PBM environment
- Proficiency with Microsoft applications
- Experience with internal reporting and analytic tools for client management
- Ability to analyze large volume of clinical data
- Attention to detail for data fidelity and integrity
- Ability to work on multiple projects and resolve complex problems
- Ability to work independently without daily supervision
- Facilitate cross-functional communication and collaboration
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.
-
Healthcare Strength — Healthcare coverage is positioned as comprehensive for benefits-eligible colleagues, including medical, dental, and vision with free preventive care and access to virtual care and select no-cost MinuteClinic services. Mental health support is also highlighted with no-cost confidential counseling sessions per issue.
-
Retirement Support — Retirement benefits include a 401(k) with a dollar-for-dollar match up to 5% after meeting service and hours requirements. Ownership programs are also offered through an employee stock purchase plan with a stated purchase discount.
-
Pay Growth & Progression — A companywide minimum wage floor establishes a baseline that is framed as a positive starting point in some roles and markets. Unionized or high-cost areas are described as having clearer wage scales and step-ups that can materially lift pay over time.
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.
