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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 hybrid role, candidate must reside within commutable distance to our Irving, TX, Northbrook, IL, Pittsburgh, PA, or Scottsdale, AZ office locations. 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

• 1-3+ 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

• 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

• Proven leadership skills

• Commitment to client service and relationship building

Education Bachelor Degree in Pharmacy required, PharmD preferred

Pay Range

The typical pay range for this role is:

$100,425.00 - $237,930.00

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. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  
 
For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 11/25/2024

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