Job Description
Job Description
This Network Quality Consultant will be working in a team that is responsible for quality management processes for our client and pharmacy pricing and claims adjudication system setups at CVS Health, a top ten Fortune company. The Network Quality Consultant will provide technical and analytical support to the team to proactively detect issues, escalate errors to the appropriate resources and drive corrective action where appropriate with excellent attention to detail. You must be well organized, deadline focused and able to make decisions quickly and efficiently working in a team and autonomous environment as a self-starter. Experience in audit-able processes and/or PBM claims auditing is helpful.
A successful candidate will have
* AS400 proficiency; experience in claims review/analysis or claims auditing.
* Advanced technical skills.
* Demonstration of Quality Management skills.
* Procedure documentation experience.
* Excellent analytical skills and problem solving abilities.
* Exceptional written and oral communication skills are a must to communicate quality assurance results.
* Attention to detail is critical, and must be extremely well organized to be successful in the role.
* Ability to articulate moderate to complex issues to varying levels of subject matter expertise/audiences.
* Strong interpersonal skills.
* Ability to manage multiple tasks simultaneously.
* Knowledge of retail pharmacy operations, network programs/procedures and claims adjudication
Pay Range
The typical pay range for this role is:
Minimum: 40,560
Maximum: 81,100
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
1+ years of Quality Assurance experience
1+ years of experience using MS Office products
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
1+ years of healthcare experience
Education
Verifiable High School diploma or GED is required.
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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