Analyst - Clinical Services

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 Analyst is responsible for ensuring the CAS and NLX prior authorization application are working as expected. Responsibilities include triaging CAS and Novologix (NLX) issues that are reported by the Operations teams and working closely with stakeholders and business partners to understand issues. Ensures integration is maintained between the Health Care Benefits (HCB) upstream systems and the CAS and NLX applications remain in sync, supporting compliance and NCQA requirements.

• Triage, submit in Greenfield, and monitor application incidents reported by the prior authorization Operations teams for Pharmacy (CAS) and Medical (NLX) clients.
• Available for on-call rotating schedule to monitor, triage and submit urgent or escalated issues during evening and weekend hours.
• Work with the Business and IT partners to ensure integration with all upstream systems and compliance with HCB regulations.

Schedule: 8:00am - 4:30pm based on individuals time zone (Must be available for on-call rotating schedule)

Required Qualifications

• IT Experience/ Technical experience
• Experience working with ServiceNow
• Comfortable with IT Terminology
• 3+ years of experience working with Commercial and Medicare clients in the CAS and NLX prior authorization applications.

Preferred Qualifications

• Excellent communication (Verbal and Written) and collaboration skills.
• Ability to research, analyze, and interpret rules and regulations, then apply them to current issues.
• Superior organization, project management, planning, and prioritization skills.
• Courteous and professional demeanor with the desire and ability to work as a team.
• Strategic, forward thinker with sound technical and analytical abilities.
• Knowledge of QA principles, practices, and procedures; and the ability to apply this knowledge to a variety of work assignments and compliance initiatives.
• Proactive preparedness qualities surrounding government regulatory understanding and approach for change management.
• Successful ability to manage multiple assignments.
• Working knowledge of Microsoft Office applications including Word, Excel, and Power Point.

Education

Associate degree or equivalent

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: 09/03/2025

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