Pharmacist - Clinical Operations Advisor

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

Job summary

A leading healthcare organization is seeking a Clinical Operations Advisor to collaborate with clients on clinical strategies and manage operations across various health plans. The role requires a Registered Pharmacist with experience in managed care and strong analytical skills. This full-time position offers a competitive salary and comprehensive benefits.

Benefits

Medical benefits

401(k)

Stock purchase

Wellness programs

Flexible schedules

Qualifications

• Active Registered Pharmacist license in the state of residence.
• 2-3+ years of relevant experience as a pharmacist in managed care.
• Understanding of CVS Health's clinical portfolio and industry trends.

Responsibilities

• Collaborate with Health Plan Clinical Advisor to create clinical operations plans.
• Design clinical setups using Caremark technology solutions.
• Manage multiple health plan clients across Medicare, Medicaid, and Commercial lines.

Skills

Communication

Data Analysis

Project Management

Collaboration

Attention to Detail

Education

Bachelor 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.

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 create a clinical operations plan. The Advisor works with the Benefit Relationship Manager and client to gather formulary and utilization management requirements, design drug-level setups for projects, and ensure compliance with internal and regulatory guidelines.

The role involves designing clinical setups using Caremark technology solutions, supporting coding teams in data loading, documenting clinical design best practices, and supporting audits of clinical setups. The Advisor manages multiple health plan clients across Medicare, Medicaid, Exchange, and Commercial lines, primarily remotely within the Central or Eastern US time zones, with up to 5% travel.

Required Qualifications

• Active Registered Pharmacist license in the state of residence
• 2-3+ years of relevant experience as a pharmacist in managed care (PBM environment)
• Understanding of CVS Health's clinical portfolio, marketplace segments, and industry trends
• Experience with Utilization and Formulary Management in managed care
• Proficiency with Microsoft Office applications and internal reporting tools
• Excellent communication skills, both verbal and written
• Ability to analyze and organize large volumes of clinical data
• Attention to detail, with a focus on data integrity and business rules
• Ability to manage multiple projects, prioritize, and solve complex problems independently
• Strong influencing and collaboration skills

Preferred Qualifications

• Experience supporting PBM clients or within a health plan
• Experience across all market segments
• Expertise in clinical programs and systems like RxClaim
• Proven leadership and client service skills

Education

Bachelor Degree in Pharmacy required; PharmD preferred

Additional Details

• 40 hours/week, full-time
• Pay range: $110,925 - $249,600, based on experience and other factors
• Benefits include medical, 401(k), stock purchase, wellness programs, flexible schedules, and more
• Application deadline: 05/28/2025