Job Description
Job Description
Join our Pharmacy Audit team in this high impact Pharmacy Network Manager role - Government Request For Information (RFI) role the candidate will act as a main point of contact among CVS Caremarks pharmacy audit investigative teams, CVS Caremark litigation department, and regulatory agencies, on behalf of CVS Caremark clients.
You will fulfill requests for time-sensitive information required by law or in support of legal processes external to CVS Caremark. A high degree of proven, decision-making ability on appropriateness of material with regard to subpoenas, government requests, HIPAA statutes, etc., is critical. You will work within strict deadlines coded in federal and state statutes (as little as 48 hours to as much as 30-day turn-around times). Failure to meet response and reporting timelines could result in sanctions against the PBM and missed contractual guarantees for CVS Caremark clients.
To be successful, you will utilize your advanced knowledge of PBM industry and claims processing systems, FWA trends, programs and initiatives. This role is preferred to be in Scottsdale, AZ; however, proven, relatable PBM network pharmacy experience and advanced manager-level retail pharmacy work experience can supersede this and may allow for a candidate to maintain a fully remote role.
The ideal candidate will also possess:
* Superior communication skills and proven experience in communicating with external parties, including but not limited to participating providers, clients, as well as developing rapport with government-facing contacts
* Strong analytical background and knowledge of PBM infrastructure, adjudication platforms and data analysis specific to the retail pharmacy providers
* Ability to make daily critical independent business decisions with minimal oversight
* Excellent communication and presentation skills with external partners (1-500 people audience)
* Strong organizational and prioritization skills; Detail-oriented and critical thinking/excellent problem-solving skills; Independent worker with a team philosophy
* Ability to understand and interpret federal/state pharmacy laws, rules and regulations
* Proven ability to successfully manage multiple projects simultaneously
* Mastery level of Microsoft Office (Word, Excel, Access, etc.) skills
Pay Range
The typical pay range for this role is:
Minimum: 60,300
Maximum: 126,600
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
* 5+ years PBM / 5+ years retail pharmacy or pharmacy audit experience
* Experience in pharmacy claim submission settings (e.g., retail, LTC/specialty/mail order/compounding pharmacy/home infusion)
COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
Preferred Qualifications
* Experience in pharmacy claim submission settings (e.g. LTC/specialty/mail order/compounding pharmacy/home infusion)
* Strong analytical background
* Ability to understand and interpret federal/state pharmacy laws, rules, and regulations
* Ability to make daily critical independent business decisions with minimal oversight
* Excellent communication and presentation skills with external partners
* Ability to build rapport through oral and written communications to external partners
* Proven experience protecting private information consistent with HIPAA, including PHI and PII
Education
* Verifiable High School diploma or GED is required
* Bachelors degree preferred
* Pharmacy technician certification preferred
Business Overview
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.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. 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.
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