CVS Health

Medicare Part D Grievances Senior Manager

Posted 6 days ago

Job Description

Job Description
As the Medicare Part D Grievances Senior Manager you will manage the operations for Medicare Part D Grievances and CTMs (complaints received by the Centers for Medicare & Medicaid Services). This includes but is not limited to; Lead the team to meet or exceed performance standards and quality expectations. Participate in CMS-facing or client-facing meetings and/or audits. Partner cross functionally and escalate internal partner issue awareness or research responses as needed. Create goals for and monitoring key performance indicators through reporting. Design forecast models and create staffing plans accordingly. Manage hiring, training and on-boarding of staff. Coordinate with client implementations for new/exiting delegated clients.

Primary duties and responsibilities;

1. Lead the CTM/GRV team to meet or exceed performance standards and quality expectations to provide best in class member experience and achieve operational excellence:
- Create goals and monitor key performance indicators through reporting
- Design forecast models and create resource plans accordingly
- Manage hiring, training and on-boarding of staff
- Drive colleague engagement through action plans corresponding to survey feedback

2. Lead and develop a team of Supervisors by focusing on key experiences, key competencies, and engagement.

3. Partner cross-functionally driving grievance-related resolution and/or escalation of internal partner research responses as needed. Collaborate to drive decreased CTM/GRV volume as opportunities arise.

4. Participate in CMS-facing or client-facing meetings and/or audits

Our ideal candidate will be organized and prioritize as well as manage multiple tasks on a regular basis with high level of detail. Having excellent oral and written communication skills and interpersonal skills is a must. Being able to adapt to change management and be self-motivated with a strong attention to detail. An ability to work in a high production, time sensitive environment while being able to prioritize and manage multiple tasks. We need a Senior Manager who demonstrates resourcefulness in problem-solving and displays confidence in the ability to learn complex material.

Required Qualifications
- 3+ years of Healthcare, Pharmacy Benefit Management (PBM) or related industry experience
- 3+ years of people leadership experience
- 1+ years of experience with computer programs, specifically Microsoft Excel, Word, Outlook, Access
- Knowledge in Windows based operations, data entry and clinical systems

Preferred Qualifications
- Knowledge of CTM/GRV business and PBM industry
- Experience in client management, leading a strong team and possession of strong relationship-building skills
- Experience in managing highly regulated and time sensitive operations, communicate effectively with all levels of leadership and colleagues, and facilitate comprehensive and timely issue resolution
- Bachelor's Degree preferred

Education
High School Diploma or GED required

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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