Pharmacist - Clinical Operations Advisor

t 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

• 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 preferredAnticipated 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 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: 05/28/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.