Clinical Services Analyst Fully Remote

Job DescriptionAs a Consultant/Quality Analyst, you will be responsible for the integrity of the prior authorization (PA) system used for Medicare Part D Coverage Determinations and Appeals. The Consultant/Quality Analyst will work closely with PA Admin and Medicare Operations to test and validate the utilization management (UM) criteria, decision trees, drug lists, and letters that are loaded and functioning properly in the PA system. The Consultant/Quality Analyst is ultimately responsible for setting up and testing the systems that will be used for the Medicare D Open Enrollment. Ensuring the quality of PA products for business users by testing cases and doing regression testing. As a Consultant/Quality Analyst developing and executing formal test plans to ensure the delivery of quality software and to ensure that all information systems products and services meet minimum organization standards and end-user requirements.Required Qualifications- 1+ years of previous testing experience - 1+ years of experience in the PBM industry - 1+ years of experience with Microsoft Office applications including Word, Excel,and AccessCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications- Project management proficiency and analytical skills- Good skills for negotiating priorities among multiple high priority business tasks- Team player with the ability to work independently- Demonstrated ability to manage multiple complex, on- going projects, as well as meet timelines for critical compliance/accreditation deliverables - Strong written and verbal communication skills, including presentation skills - Proven quality results experience - Previous analytical experience- Medicare and prior authorization experienceEducationVerifiable Bachelor's degree or two years of experience of relevant work experience for every year of degree not completed.Business OverviewBring your heart to CVS HealthEvery 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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2025-10-04