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Requisition Job Description

The Health Plan Clinical Advisor is a client facing role that manages the clinical relationship by influencing multiple key decision makers at a health plan. These include the health plan’s pharmacy support team, pharmacists, medical directors, CMO as well as other senior health plan leaders.

The HP Clinical Advisor should be able to manage at least 2 and up to 4 market segments for any particular client (Medicare, Medicaid, Exchange, and or Commercial).

The HP Clinical Advisor will manage a book of business totaling more than $XB in gross revenue, either in an individual health plan, multiple health plans, regional or national health plans.

The HP Clinical Advisor is responsible for proactively managing the clinical relationship alongside the business lead (SAE/SAD) to understand and drive each of their client’s priorities, financial targets, clinical goals and other commitments to their leadership.

The HP Clinical Advisor will analyze and evaluate the client’s data and competitive marketplace conditions and forces to develop and execute a comprehensive business plan that support the client’s short and long term profitability and growth strategies. Key components being eliminating waste, reducing inefficiency and maximizing impact to manage chronic disease. This includes:

Collaborating with clients on analysis of their key marketplace competitors and those products and services.

Consulting with and recommending standard and custom formulary options and utilization management edits.

Collaborating with internal partners to develop or modify custom programs or formularies that meet the unique needs of health plan clients.

Collaborating with CVSH trade partners on formulary strategies to maximize rebate value and drives lowest net cost.

Consulting with and recommending utilization management programs or other clinical programs to a client.

Consulting with and recommending specialty drug strategy options.

Consulting with ANCS, to utilize clinical and financial reports to evaluate current benefit design, and provide recommendations to clients on any opportunities.

Consulting and Influence clients on current drugs trends, drug pipeline, as well as proactive monitoring of FWA trends.

Consulting and influencing clients on a regular basis, developing a trusted consultative partnership that drives client loyalty and fulfills both clients commitments and CVSH goals.

The HP Clinical Advisor will consult with and advise the Clinical Benefits Pharmacist, and or other members of the Benefits and Operations teams so that those teams can timely and accurately implement a client’s requirements.

The HP Clinical Advisor will collaborate with CVSH internal partners to ensure compliance to any federal, state or local regulatory requirements that impact formulary, UM and or clinical programs and consult with any clients on the impact that such requirements might have on their plan.

The HP Clinical Advisor is accountable for ensuring that CVSH meets or exceeds any health plan client value targets each year and is responsible for proactively collaborating with business leads to identify client value and then provide consultative advice and follow up with the client on such recommendations. Consultative advice may include recommendations for program pilots, modification to existing CVSH programs to support the unique needs of the health plan segment and marketplace and/or how CVSH as an enterprise can support health plans through our open source model.

The HP Clinical Advisor is responsible to ensure they meet or exceed their personal and departmental client satisfaction scores target each year.

This position can be located in a CVSH Corporate Hub or has the ability to work remotely/work from home within the United States. Clinical Advisors must have the ability to travel up to 40% of the time.

Required Qualifications

3+ years of managed care Pharmacist experience or 1 year of Managed Care Residency program.

Active pharmacist license that is in good standing.

Demonstrated experience in a client-facing role within the managed care environment

Highly organized, detail oriented, proficient analytical ability with effective listening presentation skills are required.

Experience supporting clients within a PBM or health plan

Preferred Qualifications

3-5 years of 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

Proven leadership skills.

Strong business acumen.

Commitment to client service and relationship building.

Experience implementing template and/or customized clinical programs.

Knowledge of PBM adjudication engine and other systems leveraged in support of clients.

AMCP Fundamentals of Managed Care Pharmacy Certificate or similar professional advancement.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$110,925.00 - $249,600.00

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.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 03/10/2025

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

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.