Clinical Analyst

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.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

The Clinical Analyst role on the CVS Clinical Account Services team is a great opportunity for an individual with analytical interest to use their skills in a managed care pharmacy environment. The individual will collect, analyze, and present clinical data. The individual will evaluate healthcare information from different sources to identify trends and business insights. The individual will utilize data tools to help the Clinical Advisors (Pharmacists) respond to data requests and support strategic clinical consultation to our client(s). The Clinical Analyst will work on data requests primarily to support our Health Plan Clinical Advisors. This will include analyzing client data requests, regulatory requests, benefit documents, utilization management edits (prior authorization, quantity limits, step therapy, etc.), operational data, clinical programs and utilization management operational support. The Clinical Analyst will collect data and translate this information into the appropriate data request format, consult with account teams and client contacts to fully understand client requests, and work with internal partners to ensure the pharmacy benefit data is accurately represented per the request specifications.

Responsibilities

• Supports clinical advisors to help meet client reporting requirements, including: utilization, disruption, maintenance of business, formulary coverage, drug spend, and fraud, waste, and abuse.
• Supports clinical advisors on data needed to support regulatory requests
• Supports internal partners to maintain formulary documentation
• Clarifies needs and suggests innovative ideas to meet client/clinical advisor requests
• Provides consultative analysis of results and suggests additional analysis, if appropriate
• Supports internal partners to confirm reporting and analyses are accurate and meet client intent
  
  

Supports clinical operational needs, such as criteria and utilization management submission requirements

• Supports special projects and work groups as needed to improve efficiencies and client satisfaction
• Proactively suggests solutions and integrates best practices across multiple accounts and lines of business
• Suggests and creates innovative solutions for improving existing process flows
• Leverages pre-built and self-built tools to support Clinical Advisor data manipulation and interpretation needs
• Design and develop customized solutions to meet client needs, including driving accuracy, clarity, efficiency, and automation
• Work collaboratively with CVS Health clients during virtual meetings using a client-centered approach
• Provide guidance and best practices for available tools and existing processes
• Utilize proprietary systems, reporting tools and software (RxNavigator, RxArchitect, iTools, Tableau, Salesforce, Sharepoint, etc.) to generate necessary client reporting and conduct research
  
  

Required Qualifications

• 2 years of work experience in a health plan, PBM, Pharmacy, benefits, or insurance background
• 3 years of experience in Microsoft Office suite including proficient skills utilizing Outlook, Access, Word, Excel, and PowerPoint
  
  

Preferred Qualifications

• Not a licensed pharmacist position
• Pharmacy experience preferred
• Pharmacy Technician certification preferred
• Project Management Experience
• Strong Microsoft Office skills with an emphasis in Excel and/or Access
• 3+ years of experience in client/customer service-based environment
• Excellent communication and organization skills (able to track and handle issues, ensure the right teams are engaged, facilitate comprehensive and timely issue resolution, etc.)
• Excellent time management and multitasking skills (able to work independently and effectively manage workload)
• Strong attention to detail
• Strong analytical, and presentation skills
• Excellent knowledge of Prescription Benefit Management (PBM) industry preferred
  
  

Education

High School Diploma or GED required; Bachelor's degree

Preferred

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The Typical Pay Range For This Role Is

$43,888.00 - $85,068.00

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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
  
  

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 10/31/2025

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