Pharmacist - Clinical Operations Advisor

Job Description

The Clinical Operations Advisor is a client-facing role that collaborates with the 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 with 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 loading 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 work remotely/work from home within the United States. The 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 one state.
• 3+ years prior relevant work experience as a pharmacist in managed care (PBM) environment and/or completion of PGY1 managed care residency.
• 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 PBM 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

BS in Pharmacy or PharmD

Additional Information

• Anticipated Weekly Hours: 40
• Time Type: Full time

Compensation

The typical pay range for this role is: $110,925.00 - $228,800.00. 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.

Benefits

This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Equal Employment Opportunity

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