AMVETS Jobs

Bring your heart to CVS Health. Every 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.

Job Purpose and Summary:

As an Audit and Testing Program manager, you will provide technical, analytical, and business support for all assigned programs for Medicare, Medicaid, and Commercial products. Programs currently include End-Stage Renal Disease (ESRD), Hospice, Transplant, Transition Fill and Part D Vaccine Administration. You will support CMS program audits by delivering pertinent information in advance of audits and adequately communicate implications to ensure a successful audit experience for our clients. Your ability to research claims, read benefit setups in RxClaim, and articulate risks or concerns is critical. You will manage deliverables resulting from audit activities. These deliverables might include corrective action plans, issue narratives, and talking papers for system logic. You will be required to speak to Med D compliance and reporting documentation associated with our clinical programs. You will be expected to develop IT query writing and data analysis, business impact analysis, and root cause analysis. You will be asked to present claims in RxClaim via live webinars with CMS and clients.

The second component of this role involves year-round quality assurance testing. As new programs, processes, and technology are deployed, you will need to incorporate these into all aspects of the testing program, demonstrate validation of functionality for internal and external partners, and initiate corrective actions to resolve any issues. Your efforts around testing will ensure a smooth and successful go-live for new clients, and that CVS is able to provide all members with the appropriate and necessary access to the care they need.

Primary Job Duties & Responsibilities:

• Produce and maintain business process documentation, such as policies and procedures, job aides and work instructions as they pertain to CGP Audit and Testing.

• Support and attend CMS, Mock, and functional audits for CVS Caremark as they pertain to CGP clinical programs.

• Perform system logic testing for all clinical programs supporting CGP.

• Identify and report instances affecting performance guarantees and service level agreements.

• Provide root cause analysis through claim adjudication research and data trends.

Required Qualifications

• 3+ years of Pharmacy Benefit Management, Medicare Part D or Medicaid experience.

• 1+ years of project management or business analyst experience including the management of complex requirements.

• 1+ year Experience with the RxClaim software system.

• Ability to travel up to 20%.

Preferred Qualifications

• Experience using RxNavigator to review and develop reports.

• Experience analyzing large data files to find root cause.

• Experience delivering presentations to client s.

• In-depth knowledge of pharmacy products, services, and system capabilities.

Education

• Bachelor’s degree required.

• Equivalent experience may be considered.

Pay Range

The typical pay range for this role is:

$54,300.00 - $139,200.00

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. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 05/13/2024

We are an equal opportunity and affirmative action employer. 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.