Clinical Services Consultant

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose : Bringing our heart to every moment of your health.

This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand with heart at its center our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary

The Clinical Services Consultant fulfills the company purpose of helping people on their path to better health by driving quality execution of administrative support for Prior Authorization.

The Clinical Services Consultant will be a Clinical Authorization System Subject Matter Expert providing support for the Prior Authorization / Appeals Operational and Client Support teams.

This position works closely with and fosters communications with internal and external departments including Legal, IT Teams, Clinical Development, Product Owners, CAS liaisons, Account Teams and Prior Authorization Operations to ensure effective execution of programs being processed and implemented.

• The Clinical Services Consultant will participate in projects and activities related to the Clinical Authorization System including configuration and process improvements;
• Coordination and assistance in executing user acceptance testing for system enhancements; Managing workflows for specific lines of business including case management;
• Utilizing feedback from user groups to work with IT and the business to develop and deploy system enhancements; Documenting ideas for enhancements;

Facilitating meetings; Ensuring projects and system enhancements meet both state and federal requirements. In addition, work with a team of system trainers to provide consistent back end user support, assist in documentation and maintenance of user guides presentations and corrective action plans, provide system demos and help guide CAS users through the implementation process for Prior Authorization system tool.

Required Qualifications

• 5 years of work experience in Customer Service in Healthcare
• Proficiency with MS Excel, Word and PowerPoint including formatting of documentation and data tracking
• Interpretation of regulations and communicating that interpretation to others
• Strong CAS and / or MedHOK systems knowledge preferred
• Self-motivated and ability to adapt to change quickly
• Ability to meet strict deadlines
• Proven capability to work with people at all levels of an organization
• Exceptional written and verbal communication skills and presentation skills

Preferred Qualifications

• Knowledge of Prior Authorization and activities preferred
• Proven ability to manage and prioritize multiple projects simultaneously and meet deadlines.
• Experience working with Salesforce preferred
• Ability to apply analytical thinking to problem resolution

Education

High School Diploma or equivalent GED

Pay Range

The typical pay range for this role is :

$18.50 - $35.29

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.