Analyst - Clinical Services

The Analyst, Clinical Services is responsible for developing, executing, and maintaining test plans and test cases that ensure the CAS (prior authorization) application is working as expected for the pharmacy prior authorization operations management teams. The Analyst is also responsible for working closely with stakeholders and business partners to understand enhancements and how best to develop test plans for optimal outcomes.

The Analyst is also responsible for triaging CAS issues that are reported by the Operations teams.

Ensures integration is maintained between the Health Care Benefits (HCB) upstream systems and the CAS application remain in sync, supporting compliance and NCQA requirements.

1. Test Case Creation: Create well defined test plan, test case, test results documents for CAS applications to ensure full new feature and regression testing.

2. Test Case Execution: Manually execute well defined test plans and test cases, as well as documenting test results for the CAS application to ensure new feature and regression testing.

3. Understanding UAT Scope: Create/identify test data for testing scenarios from the frontend and backend application and perform detailed frontend, as well as backend testing (UAT) to ensure the results are in line with the requirements from a business perspective.

4. Subject Matter Expert: Participate in grooming sessions to provide input to business requirements for functional enhancements or client activations/implementations that impact the delegated Commercial functions, with the goal of maintaining standardization across the delegated Commercial clients.

5. Incident Management: Triage, submit in Service Now, and monitor CAS application incidents reported by the Operations teams for Pharmacy delegated clients. This includes an on-call rotating schedule to monitor, triage and submit urgent or escalated issues during evening and weekend hours.

6. Release and Shakeout: Attend release shakeouts with IT, Product, Business, QA, Account Management, and Operations teams to test functionality prior to it being released into the Production environment.

7. Partners Across Boundaries: Work with the Business and IT partners to ensure integration with all upstream systems and compliance with HCB regulations.Required Qualifications

• Ability to work efficiently and effectively in a cross-functional team setting with colleagues from multiple business segments and levels.
• Superior communication, organization, project management, and prioritization.
• Results-oriented individual that is able to independently work on multiple projects in fast paced, multi-tasking team environment while meeting deadlines.
• Excellent presentation and communication skills/techniques; ability to work collaboratively in a cross-functional team environment to solve challenging issues and identify opportunities for improvement.

Preferred Qualifications

• 4-6 years of relevant work experience required that includes supporting clinical PBM products and application support.
• Ability to understand complex problems, identify technical solutions, and define business requirements to support the solution.
• User acceptance testing experience.
• Technical writing experience.
• Understanding of PBM and clinical products.
• Ability to apply that knowledge and interpret into technical system requirements, answer project questions, conduct user acceptance testing, and implementation of enhancements to Operations.
• Bachelors Degree

Education
High School Diploma or Equivalent Anticipated Weekly Hours
40Time Type
Full timePay Range

The typical pay range for this role is:$43,888.00 - $85,068.00This 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 peopleWe 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/benefitsWe anticipate the application window for this opening will close on: 06/28/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.