Clinical Client Operations - Analyst

CVS Health•Woonsocket, RI

5d•Onsite

About The Position

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. The PA Data Management (PDM) team oversees a wide range of Prior Authorization (PA) data flows, tools, and projects. We are committed to enhancing quality and operational efficiency by developing advanced methods for managing data that minimize downstream issues while accounting for upstream variances. We empower our team members to build deep expertise in PA configuration, adapt to evolving plan designs, formulary and product changes, and collaborate effectively to support both internal stakeholders and external clients. Our vision is to foster a culture of accountability, innovation, and service excellence that drives meaningful impact across the healthcare ecosystem through robust data management practices. Position Summary As a PA Data Management Analyst, you will play a key role in supporting and optimizing PA operations through data-driven insights and process improvements. You will work collaboratively across teams to manage PA data flows, support client implementations, and contribute to the development of scalable, automated solutions that enhance quality and reduce risk.

Requirements

Self-motivated with a strong, positive attitude and a proactive approach to problem-solving.
Excellent communication and organizational skills; able to articulate complex technical concepts to non-technical audiences.
2+ years of experience analyzing large data sets to identify trends, opportunities, and support initiatives.
Proficiency in the following programming languages: Transact-SQL VB C#
Software proficiency in: Visual Studio SQL Server Management Studio Microsoft Office Suite (Word, PowerPoint, Excel, Outlook, Access)

Nice To Haves

Experience with RxClaim, specifically adjudication related to Prior Authorization overrides.
Knowledge of CVS Caremark clinical programs, including formularies and utilization management.
Familiarity with various lines of business: Commercial, Medicare, Medicaid, Health Exchanges.
Experience in developing or improving training materials for technical and clinical audiences.

Responsibilities

Manage and maintain PA-related data flows, ensuring accuracy, consistency, and alignment with upstream and downstream systems.
Support the development and enhancement of internal tools and processes to improve data quality and operational efficiency.
Analyze large datasets to identify trends, anomalies, and opportunities for process improvement.
Collaborate with cross-functional teams to support client implementations, plan design changes, and formulary updates.
Participate in testing and validation efforts for PA configuration and data transition activities.
Assist in documenting business requirements and operational procedures related to PA data management.
Contribute to the creation and refinement of training materials and knowledge resources for internal stakeholders.
Support ongoing initiatives aimed at automation, scalability, and proactive risk mitigation within PA operations.
Support Clinical Adjudication PA Support Team with general case work as and when needed.