Position SummaryThe 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 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
- Demonstrated experience in a client-facing role within PBM 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
EducationBachelor Degree in Pharmacy required, PharmD preferred
Active, unrestricted pharmacist licensure required
Anticipated Weekly Hours40
Time TypeFull time
Pay RangeThe 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.
Great benefits for great peopleWe take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
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 for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 06/10/2026
