Clinical Supervisor - Clinical & Government Services ...

Job DescriptionThe Clinical Supervisor, Clinical & Government Services Ops, Case Monitoring Team, is responsible for leading a team of clinicians (and possibly non-clinicians) that monitor the quality of coverage determinations, appeals, and organization determinations completed by the Government Services Operations Team. The Supervisor must be able to lead a team that may include pharmacists, nurses, pharmacy technicians, and senior consultants to ensure that coverage determination and organizational determination requests are completed accurately. The Clinical Supervisor is responsible for managing the productivity, daily activities, quality and attendance of the team. This leader is responsible for the team's case monitoring including post-completion and targeted reviews of work products to identify and remediate risk in real-time and to provide performance management capabilities for the Operations teams. This individual is responsible for creating and/or maintaining standard operation procedure documentation. The Supervisor will lead the continuous improvement activities within the team, support continuous improvement projects across the broader Government Services Organization, and will need to be able to have critical thinking skills to problem solve/root cause complex clinical and operational priorities, and propose possible solutions. The supervisor must be knowledgeable in all aspects of the organization determination, coverage determination and appeals processes and assist in meeting client expectations regarding efficiency, services levels, privacy maintenance and quality decision making.Pay RangeThe typical pay range for this role is:Minimum: 82,000Maximum: 176,800Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required Qualifications1. 3+ years in Medicare or Health plan experience 2. Experienced in executing succession plans 3. Able to develop strategic roadmaps for systems and processes used for quality monitoring 4. Strong MedHOK, Novologix and CAS systems knowledge preferred5. Organize, prioritize, and manage multiple tasks on a regular basis with high level of detail 6. Excellent Oral and Written communication skills and interpersonal skills7. Customer Service internally and externally8. Ability to meet strict deadlines9. Adaption to Change 10. Self-motivated with a strong attention to detail11. Ability to work in a high production, time sensitive environment12. Able to prioritize and manage multiple tasks13. Demonstrates resourcefulness in problem-solving 14. Displays confidence in the ability to learn complex material15. Computer Knowledge including: Microsoft office products, Windows based operations, data entry and clinical systems 16. Licensed Pharmacist.COVID 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 QualificationsMasters or Doctorate of Pharmacy DegreeMedHOK experienceMedicare Part B and D experienceNovologix ExperienceExperience with My/WebQATeam PlayerDetail OrientedExcellent communication skillsMulti tasking skillsAdapts to changeEducationBachelor's Degree in PharmacyBusiness 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: 2026-03-07