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Position Summary

The Advanced Clinical Advocate Nurse Practitioner (NP) serves as a senior clinical resource supporting providers, members, and internal clinical teams in navigating complex pharmacy and imaging-related care needs. This role functions as a clinical liaison between providers, pharmacy, imaging, and operational teams to promote timely access to medically appropriate care, facilitate clinical collaboration, and support evidence-based decision-making.

The Advanced Clinical Advocate NP leverages advanced clinical expertise to engage providers, evaluate complex clinical scenarios, identify barriers to care, and facilitate appropriate next steps that support quality outcomes and an improved provider experience.

This position is not a direct patient care role and does not provide retail, primary care, urgent care, or in-home clinical services.

Primary Responsibilities

Clinical Advocacy and Consultation

· Serve as a clinical resource for complex pharmacy and imaging-related cases.

· Collaborate with providers to clarify clinical needs, treatment intent, and supporting clinical information.

· Evaluate clinical scenarios and identify opportunities to support timely access to appropriate care and services.

· Apply advanced clinical judgment to support evidence-based decision-making.

· Facilitate resolution of complex clinical questions through collaboration with providers, pharmacists, nurses, and interdisciplinary teams.

Provider Engagement

· Conduct clinical outreach and provider-to-provider consultations regarding complex care requests.

· Partner with ordering and prescribing providers to better understand unique clinical circumstances and treatment goals.

· Support productive clinical dialogue that promotes appropriate care planning and informed decision-making.

· Build collaborative relationships with provider partners and serve as a trusted clinical resource.

Cross-Functional Collaboration

· Function as a clinical liaison between pharmacy, imaging, operational, and clinical teams.

· Partner with pharmacists, nurses, care teams, and other stakeholders to address complex clinical situations.

· Escalate clinically complex cases when additional expertise or review is required.

· Support efficient care coordination and reduce unnecessary barriers that may impact treatment initiation.

· Promote a seamless provider experience through proactive communication and collaboration.

Quality and Process Improvement

· Identify trends, opportunities, and barriers impacting care access and provider experience.

· Provide feedback regarding clinical documentation, workflow opportunities, and process improvement initiatives.

· Participate in quality, compliance, and clinical calibration activities.

· Contribute to initiatives designed to improve care access, provider satisfaction, and overall healthcare experience.

· Support continuous improvement efforts focused on clinical quality and operational excellence.

Required Qualifications

· Active, unrestricted Nurse Practitioner license with the ability to obtain and maintain multi-state licensure as required.

· Current national board certification through ANCC, AANP, or another nationally recognized certifying body.

· Minimum of five (5) years of advanced clinical practice experience.

· Demonstrated clinical expertise in complex care management, specialty care, managed care, pharmacy, imaging, utilization support, or related healthcare settings.

· Strong clinical assessment, critical thinking, and decision-making skills.

· Experience collaborating directly with physicians, specialists, and advanced practice providers.

· Excellent verbal and written communication skills.

· Ability to interpret clinical information, evidence-based guidelines, and healthcare policies to support informed clinical recommendations.

Preferred Qualifications

· Experience supporting pharmacy and/or imaging-related clinical programs.

· Prior managed care, health plan, payer, specialty care, or population health experience.

· Experience conducting provider-to-provider clinical consultations.

· Familiarity with evidence-based clinical guidelines and clinical decision support tools.

· Experience collaborating with Medical Directors and interdisciplinary clinical leadership teams.

· Knowledge of healthcare regulations, accreditation standards, and quality improvement methodologies.

Key Competencies

· Advanced clinical judgment

· Clinical advocacy

· Provider engagement and consultation

· Collaborative problem solving

· Relationship management

· Critical thinking and decision-making

· Healthcare navigation expertise

· Effective communication and influence

· Quality improvement mindset

· Attention to detail and documentation excellence

Position Clarification

· Does not provide direct patient care.

· Does not function as a retail, primary care, urgent care, or home-based Nurse Practitioner.

· Does not conduct in-home assessments.

· Serves as an advanced clinical advocate focused on supporting providers, improving access to care, facilitating clinical collaboration, and promoting high-quality clinical outcomes.

· Partners across pharmacy, imaging, operational, and clinical teams to address complex healthcare needs and support a positive provider and member experience.

This role is designed for experienced Nurse Practitioners who are passionate about clinical advocacy, provider partnership, healthcare navigation, and improving access to medically appropriate care through collaboration and clinical expertise.

Work from Home Requirements:

- You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and

a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted.

- A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS

Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.

- Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.

- The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own

workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).

- If hired, you will commit to obtaining required internet speeds and...

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