Pharmacist - Clinical Operations Advisor

Hispanic Alliance for Career Enhancement; Columbia (SC); Remote; USD 110,000 - 250,000; Full time

Job summary

A leading health solutions company is seeking a Clinical Operations Advisor to manage clinical operations for health plan clients. This remote role requires a Registered Pharmacist with experience in managed care, strong analytical skills, and the ability to engage stakeholders effectively. The position offers a competitive salary, comprehensive benefits, and opportunities for professional growth.

Benefits

Comprehensive medical plans

401(k) plan

Employee stock purchase

Wellness programs

Flexible schedules

Qualifications

• Active Registered Pharmacist license required.
• 2-3+ years of experience in managed care.
• Proficiency in Microsoft Office applications.

Responsibilities

• Collaborate with Health Plan Clinical Advisor to develop clinical operations plans.
• Manage multiple health plan clients across various lines of business.
• Support internal and client audits of clinical setups.

Skills

Communication

Analytical Skills

Attention to Detail

Project Management

Consultative Skills

Education

Bachelor's Degree in Pharmacy

Tools

Microsoft Office

RxClaim

Job description

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.

Position Summary

The Clinical Operations Advisor is a client-facing role that collaborates with the Health Plan Clinical Advisor to understand the client's clinical strategy and develop a clinical operations plan. The role involves working with the Benefit Relationship Manager and clients to gather formulary and utilization management requirements, designing drug-level setups for projects, and ensuring compliance with internal best practices and federal and state guidelines.

The advisor designs clinical setups using Caremark technology solutions, supports coding teams in loading clinical data into the adjudication system, and partners with account teams to document clinical design best practices, streamline processes, and identify opportunities for efficiency and accuracy improvements. They also support internal and client audits of clinical setups within adjudication systems, verifying client-approved requirements and designs.

This role requires managing multiple health plan clients across various lines of business, including Medicare, Medicaid, Exchange, and Commercial. It is a remote position, open to qualified candidates within the Central or Eastern time zones of the United States, with travel up to 5% as needed.

Required Qualifications

• Active Registered Pharmacist license in the state of residence
• 2-3+ years of relevant experience as a pharmacist in a managed care environment (Pharmacy Benefit Management)
• Understanding of CVS Health's clinical portfolio, marketplace segments, and industry trends
• Experience with Utilization Management and Formulary Management in managed care
• Proficiency in Microsoft Office applications (Excel, PowerPoint, Word, Outlook, Access, Teams)
• Experience with CVS Health's internal reporting and analytics tools or industry equivalents
• Excellent written and verbal communication skills, both virtually and in person
• Ability to analyze large volumes of clinical data and organize it for downstream teams
• Attention to detail to ensure data fidelity and integrity, including understanding business rules for data transformation
• Ability to manage multiple projects, prioritize tasks, and resolve complex problems
• Ability to work independently without daily supervision
• Impactful and influential in stakeholder engagement
• Results-driven with a focus on goals and commitments
• Facilitation skills for cross-functional communication and collaboration
• Consultative and influential skills with internal stakeholders and clients

Preferred Qualifications

• Experience supporting PBM clients or within a health plan
• Experience across all market segments (Medicare, Medicaid, Exchange, Commercial)
• Expertise in Utilization Management, Formulary Management, and Clinical Products
• Experience implementing clinical programs, customized or templated
• Knowledge of PBM adjudication engines and related systems
• Experience with RxClaim
• Proven leadership skills
• Strong commitment to client service and relationship building

Education

Bachelor's Degree in Pharmacy required; PharmD preferred

Additional Details

Anticipated weekly hours: 40

Time type: Full-time

Pay range: $110,925.00 - $249,600.00, depending on experience and other factors. The position may be eligible for bonuses or incentives.

We offer comprehensive benefits, including medical plans, 401(k), employee stock purchase, wellness programs, paid time off, flexible schedules, and more. For details, visit our benefits page.

The application window closes on 05/28/2025. Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws.