Clinical Operations Advisor in Irving, Texas | DiversityInc Careers
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Clinical Operations Advisor

Job Description
As the Clinical Operations Advisor you will collaborate with our Clinical Pharmacists, Senior Consultants, and Consultants including Clinical Requirement Advisors and Benefit Relationship Managers to support impactful clinical initiatives. You will act as an expert on clinical benefit plan design for standard and custom products for our health plan clients. You will have additional responsibilities to include:
- Analyzing data for Formulary and utilization management
- Partnering with key clinical product owners to effectively align plan design with those key products
- Researching and Identifying gaps in plan design as it relates to accurate adjudication
- Solving critical issues, and mitigating future challenges

Your success will be defined by your ability to produce coding requirements for key clinical programs and your timely review of RxClaim changes for accuracy. You will be heavily involved in document review,current system validation, trending analysis, and supporting ad hoc situations.You will be a key contributor recommending coding changes based on your collaboration with internal and external clients. The contributions that you will make will help to position CVS Health as leader in the PBM Marketplace.

Required Qualifications
* 5 or more years of experience benefit plan design, data analysis or a related field
* 3+ years of RxClaim experience
* Minimal Travel may be required

Preferred Qualifications
* SalesForce proficiency
* Ability to effectively work within a team
* Demonstrable ability to analyze data and determine conclusions and provide solutions
* Ability to learn and apply increasingly complex concepts, policies and procedures
* Proven advanced level usage of the Microsoft Office Suite, to include Excel and Access
* Skilled in identifying and solving issues and recommending process improvements
* Ability to work successfully in a dynamic, client focused environment
* Experience with Formulary, Utilization Management and Medicare Part D

* Bachelor’s Degree is required
* Equivalent combination of education and experience may be considered

Business Overview
CVS Health, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units – MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.

CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law. CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance to apply for this job, please contact us by clicking EEO AA CVS Health

CVS Health does not require nor expect that applicants disclose their compensation history during the application, interview, and hiring process.

For inquiries related to the application process or technical issues please contact the Kenexa Helpdesk at 1-855-338-5609. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352. Please note that we only accept resumes via our corporate website: