Clinical Client Operations - Analyst

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.

The PA Data Management (PDM) team oversees a wide range of Prior Authorization (PA) data flows, tools, and projects. We are committed to enhancing quality and operational efficiency by developing advanced methods for managing data that minimize downstream issues while accounting for upstream variances.

We empower our team members to build deep expertise in PA configuration, adapt to evolving plan designs, formulary and product changes, and collaborate effectively to support both internal stakeholders and external clients. Our vision is to foster a culture of accountability, innovation, and service excellence that drives meaningful impact across the healthcare ecosystem through robust data management practices.

Position Summary

As a PA Data Management Analyst, you will play a key role in supporting and optimizing PA operations through data-driven insights and process improvements. You will work collaboratively across teams to manage PA data flows, support client implementations, and contribute to the development of scalable, automated solutions that enhance quality and reduce risk.

Key Responsibilities

• Manage and maintain PA-related data flows, ensuring accuracy, consistency, and alignment with upstream and downstream systems.
• Support the development and enhancement of internal tools and processes to improve data quality and operational efficiency.
• Analyze large datasets to identify trends, anomalies, and opportunities for process improvement.
• Collaborate with cross-functional teams to support client implementations, plan design changes, and formulary updates.
• Participate in testing and validation efforts for PA configuration and data transition activities.
• Assist in documenting business requirements and operational procedures related to PA data management.
• Contribute to the creation and refinement of training materials and knowledge resources for internal stakeholders.
• Support ongoing initiatives aimed at automation, scalability, and proactive risk mitigation within PA operations.
• Support Clinical Adjudication PA Support Team with general case work as and when needed.

Required Qualifications

• Self-motivated with a strong, positive attitude and a proactive approach to problem-solving.
• Excellent communication and organizational skills; able to articulate complex technical concepts to non-technical audiences.
• 2+ years of experience analyzing large data sets to identify trends, opportunities, and support initiatives.
• Proficiency in the following programming languages:
  • Transact-SQL
  • VB
  • C#
• Software proficiency in:
  • Visual Studio
  • SQL Server Management Studio
  • Microsoft Office Suite (Word, PowerPoint, Excel, Outlook, Access)

Preferred Qualifications

• Experience with RxClaim, specifically adjudication related to Prior Authorization overrides.
• Knowledge of CVS Caremark clinical programs, including formularies and utilization management.
• Familiarity with various lines of business: Commercial, Medicare, Medicaid, Health Exchanges.
• Experience in developing or improving training materials for technical and clinical audiences.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$43,888.00 - $93,574.00

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. 
 

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