Scottsdale, Arizona

Job Description
As the Medicare Pharmacy Audit Programs Project Manager you will be responsible for administering Medicare Part D Pharmacy Audit programs. In this role, you will be expected to familiarize yourself with all the Medicare Audit Programs and become a subject-matter-expert on assigned audit programs. As new CMS guidance is released each year, you will be required to develop solutions to flexibly adapt the Medicare Audit Programs to comply with new requirements and new programs. You must utilize critical thinking skills to make business-critical decisions and develop strategies to maximize client compliance integrity. You will utilize a wide variety of skills and technological resources to assist in this task--and will develop new processes and systems along the way through claim and trending investigation and analytics. Some of your key responsibilities will include:
- Developing new Audit Systems and enhancing current audit systems
- Administering audit programs, including oversight of the audit process and architecture
- Conducting pharmacy outreach, collaborating with internal team members to accomplish your goals
- Analyzing and summarizing audit results using SQL coding analytics
- Coordinating the correction of Medicare D claims and PDEs

These audit processes help keep CVS Health plans in compliance with CMS requirements and maintain positive STAR ratings. As part of this you will also be responsible for reviewing and interpreting CMS guidance. Lastly, you will be responsible for coaching, mentoring, and developing staff auditors to enhance the process efficiency of our services. You will be required to work independently within a team philosophy, and collaborate directly with both internal partners and external clients.

Required Qualifications
* 5 or more years’ experience with CVS Caremark or another PBM
* 3 or more years’ experience in a role interacting with PBM pharmacy claims

COVID Requirements
CVS Health requires its 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, or religious belief that prevents them from being vaccinated.

If you are 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 within the first 10 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 45 days of your employment. In some states and roles, you may be required to provide proof of full vaccination before you can begin to actively work. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.

If you are unable to be fully vaccinated due to disability, medical condition, or religious belief, you will be required to apply for a reasonable accommodation within the first 10 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. In some states and roles, you may be required to have an approved reasonable accommodation before you can begin to actively work. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications
- Highly proficient software application skills including the Microsoft Office suite, Microsoft Excel, Microsoft Access, SQL coding, Teradata, RxClaim, Recap, Salesforce, Sharepoint, VBRX
- Nationally Certified Pharmacy Technician (PTCB)
- Experience in Medicare D pharmacy audit programs
- Experience using SQL code to query and analyze database systems
- Experience conducting Pharmacy Audits
- Excellent written and verbal communication skills
- Excellent teamwork and collaboration abilities, self-driven attitude
- Excellent mentorship and coaching skills
- Thorough knowledge of PBM and pharmacy industry
- Experience in process or project management
- Ability to work under pressure to meet critical deadlines

Education
* Bachelor's Degree Required
* Equivalent combination of education and experience may be considered

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. See Job Description

Scottsdale, Arizona

Continue serving and work with a purpose

As a CVS Health colleague, you'll find career opportunities across the organization and at every stage of your career. More important, your work will have an impactful purpose on someone's life, including your own. Learn more about how you can continue serving on your next mission at CVS Health.

Careers for Veterans and Military Spouses

 

"The military has an ethos that is grounded in purpose-driven service that’s bigger than the individual. The same holds true for us at CVS Health. You can talk to colleagues in any part of our business and they will be able to articulate our company’s purpose. Working here provides an opportunity for service members and military spouses to continue to serve, just in a civvies."

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