Job Category: Account Management, Medicare
Clinical Licensure Required : N/A
Job Type: Full Time Position Summary:
This position will provide Client Service support for the utilization management programs managed under Medicare Clinical Operations. This position is responsible for the strategic objectives for supporting and implementing existing and new Medicare clients into the prior authorization system. This individual will work closely with Medicare Operations, Clinical business partners, PA Admin, Account Teams, and assigned Clients to ensure that all areas of implementation are loaded and functioning properly on the Med D client prior authorization application. Responsibilities include managing client implementation timeline, ensure all operational areas are ready by go live, identify process improvements, represent Medicare Clinical Operations in client meetings. Serve as the clinical subject matter expert for Medicare Part D coverage determination system and appeals system. Communicate issues and recommend resolutions for prior authorization organization and clients. Partner with internal partners to address any actions to be taken by Medicare Clinical Operations on behalf of Clients, such as client tours, audits, presentations, issue resolution, training and communication. Required Qualifications:
Bachelor's degree required. Minimum of 9 years work experience. Advance degree desirable. PBM experience required. Preferred Qualifications:
Utilization management or prior authorization knowledge required. Medicare experience preferred. Education:
Advance degree desirable. Business Overview:
CVS Caremark, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day.
As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units – MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.
CVS Health - 2 years ago
Millions of times a day, close to home and across the country, we’re helping people on their path to better health.