Clinical Manager, Clinical Operations
Spring HealthSalary not specified
Full Time
Mid-level (3 to 4 years), Senior (5 to 8 years)
Not SpecifiedCompensation
Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare, Pharmacy Benefits ManagementIndustries
Requirements
- 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
- Ability to travel up to 5% of the time
- Qualified candidates within the Central or Eastern time zones of the United States
Responsibilities
- Collaborate with Health Plan Clinical Advisor to understand the client’s clinical strategy and roadmap to create a clinical operations plan
- Work with the Benefit Relationship Manager and client to facilitate gathering formulary and utilization management requirements
- Design the drug level setup for projects on the operations plan while ensuring compliance to internal best practice and federal and state guidelines
- Design the clinical setups using Caremark technology solutions
- Support the coding teams in the loading of clinical data into the adjudication system
- Partner with account team members to document clinical design best practices
- Provide input to streamline processes
- Identify opportunities to improve the efficiency and accuracy of clinical setups
- Support internal and client audits of clinical setups within adjudication systems, including verifying the client approved requirements and design
- Manage multiple health plan clients across multiple lines of business including Medicare, Medicaid, Exchange, and Commercial
Skills
Key technologies and capabilities for this role
Questions & Answers
Common questions about this position
Is this position remote?
Yes, this is a remote role open to qualified candidates within the Central or Eastern time zones of the United States, with up to 5% travel required.
What qualifications are required for this role?
Candidates must have an active Registered Pharmacist license in their state of residence, 2-3+ years of prior relevant work experience as a pharmacist in a managed care (Pharmacy Benefit Management) environment, demonstrated experience with Utilization Management and Formulary Management, and experience in a client-facing role within a PBM environment.
What skills are needed for the Clinical Operations Advisor position?
Key skills include proficiency with Microsoft applications (Excel, PowerPoint, Word, Outlook, Access, Teams), excellent written and verbal communication skills both virtually and in person, and the ability to analyze large volumes of clinical data.
What is the salary for this position?
This information is not specified in the job description.
What experience stands out for a strong application?
A strong candidate will have an active pharmacist license, 2-3+ years in a PBM environment, demonstrated understanding of CVS Health's clinical portfolio and marketplace segments like Medicare and Medicaid, plus client-facing experience in utilization and formulary management.
CVS Health
Comprehensive pharmacy and healthcare services
About CVS Health
CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.
Woonsocket, Rhode IslandHeadquarters
1963Year Founded
DEBTCompany Stage
Healthcare, Consumer GoodsIndustries
10,001+Employees
Benefits
Health Insurance
Dental Insurance
Vision Insurance
Life Insurance
Disability Insurance
401(k) Retirement Plan
Company Equity
Wellness Program
Professional Development Budget
Paid Vacation
Paid Holidays
Risks
Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.
The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.
The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.
Differentiation
CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.
The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.
CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.
Upsides
Expansion of telehealth services allows CVS to reach more patients remotely.
Increased consumer interest in wellness boosts demand for CVS's health-related products.
The trend towards value-based care aligns with CVS's integrated healthcare approach.
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