We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.
This position is 100% remote and can be located anywhere in the USA.
Position Summary
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 Health Plan Clinical Advisor should be able to manage at least 2 and up to 4 market segments for any particular client (Medicare, Medicaid, Exchange, or Commercial). This role will have Medicare as the primary line of business responsibilities.
The Health Plan 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 Health Plan Clinical Advisor will work cross-functionally with internal partners (e.g., Sales, Trade, Finance, Specialty, UM) to optimize product offerings that align with client capabilities and organizational strategy.
The Health Plan 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 supports 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.
Conducting Provider and Member outreach as needed for client communications.
Consulting with regulatory and legal teams to advise clients of compliance within regulations
Helping the client to define clinical program strategies around STARS and quality initiatives. (i.e. MTM, CAHPS, STARS, Part B and C where applicable, SUPD, etc.)
The Health Plan 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 Health Plan 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 Health Plan 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 Health Plan Clinical Advisor is responsible for ensuring 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 can work remotely/work from home within the U.S. Clinical Advisors must have the ability to travel up to 25% of the time.
Required Qualifications
3+ years of managed care Pharmacist experience and/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
Demonstrated understanding of and experience with utilization management trends and programs within the managed care environment
Highly organized, detail oriented, proficient analytical ability with effective listening & presentation skills are required.
Preferred Qualifications
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.) Medicare will be the primary focus of this role.
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.
Education
BS in Pharmacy or PharmD
Active, unrestricted pharmacist licensure in at least 1 state
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$123,250.00 - $208,000.00
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.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments (https://learn.bswift.com/cvshealth-mainland) .
We anticipate the application window for this opening will close on: 06/30/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran - committed to diversity in the workplace.
