Pharmacist - Clinical Operations Advisor

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
 
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

The Clinical Operations Advisor is a client facing role that collaborates with HP 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 set up 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 set ups 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 set ups. 

The Clinical Operational Advisor supports internal and client audits of clinical set ups 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 position can be located in a CVSH Corporate Hub or has the ability to work remotely/work from home within the United States. Clinical Operations Advisor must have the ability to travel up to 5% of the time. 

Required Qualifications

• Pharmacist – Active Registered Pharmacist license in at least 1 state.

• 1-3+ years prior relevant work experience as a pharmacist in managed care (PBM) 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 wtih 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  

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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