CVS Health

Remote/Telecommute

Prescription Insurance Benefits Verification - Operations Manager

Posted over 1 month ago

Job Description

Job Description
CVS Health, a Fortune 5 company, has an exciting opportunity for a Prescription Insurance Benefits Verification Manager to join our growing team. This position will oversee the prior authorization refill team and the proactive reauthorization team which are located in Monroeville, Pennsylvania and Orlando, Florida. You will lead process improvement, organizing, directing, and controlling the activities of the Benefits Verification department. You will ensure patient benefits are verified in accordance to the company guidelines and that patient expectations are met.

To be successful in the is role you will have superb management and business process skills and the ability advise the management team with respect to medical insurance requirements, customer service and pharmacy operations. You will have the ability to work in teams and coordinate work efforts. The Manager will also have excellent communication, organizational, and social skills and pay attention to customer focus to ensure patients are responded to with accurate and timely information.

Additional responsibilities include:
* Accountability for service performance, customer happiness and financial performance.
* Responding to inquiries or complaints from customers, healthcare providers, and/or members.
* Providing effective leadership and direction to all direct reports while managing and encouraging a dynamic and progressive work environment characterized by high integrity, efficiency, quality and a commitment to perfection and respect.
* Coordinating staffing needs for the department in collaboration with recruiting and human resources.
* Assisting with implementation of new pharmacy programs.
* Facilitating communication for problem resolution and changes occurring in the organization, within Specialty Pharmacy or with other departments that may impact the Benefits Verification department.
* Communicating with managers and directors of other departments to discuss cross-departmental issues and identify potential solutions.

This is a work from home opportunity. However, you must be located near Monroeville, PA; Buffalo Grove or Mt. Prospect, IL; Orlando, FL, or Dallas, TX.

Required Qualifications
* 5 years of management experience in a high intensity healthcare organization or operations environment.
* 5 years of operational leadership experience managing multiple teams.

Preferred Qualifications
* Specialty pharmacy or mail service pharmacy experience.
* Knowledge of Pharmacy regulations.
* Experience in prescription and major medical benefits related to pharmacy products.
* Experience managing remote teams that are both exempt and non-exempt
* Experience with prior authorization process including but not limited to researching and initiating prior authorizations

Education
* Bachelors Degree or equivalent work experience

Business Overview
At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.


We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

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