Clinical Client Operations - Analyst at CVS Health in Woonsocket, RI

Clinical Client Operations - Analyst Location: RI - Woonsocket 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. ThePA 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 ofaccountability, innovation, and service excellencethat drives meaningful impact across the healthcare ecosystem through robust data management practices. Position Summary As aPA 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. Key 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. Required Qualifications 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) Preferred Qualifications Experience withRxClaim, specifically adjudication related toPrior Authorization overrides. Knowledge ofCVS Caremark clinical programs, includingformulariesandutilization management. Familiarity with various lines of business:Commercial, Medicare, Medicaid, Health Exchanges. Experience indeveloping or improving training materialsfor technical and clinical audiences. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $43,888.00 - $93,574.00 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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will close on: 05/12/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.