At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position SummaryThe CVS Health Women's Health and Genomics team is part of the Medical Affairs organization responsible for advancing the highest clinical quality standards, increasing access to care, improving patient outcomes and reducing avoidable health care costs across the enterprise. We deliver effective and efficient solutions that span a broad range of clinical priorities and initiatives.The Lead Director, Genomics, Precision Medicine and Value Measurement, is responsible for driving improved clinical quality and cost effectiveness of health care by utilizing genomics, precision medicine, and women's health solutions.
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These innovative and advanced solutions will drive improvements in clinical outcomes, reduce health care costs, and increase revenue capture opportunities throughout the CVS Health enterprise.
This position will be reporting into the Executive Director.Leveraging clinical knowledge, payer experience, and insight into the possibilities of precision medicine, this individual will have opportunities to inspire business leads to innovate and deliver valuable genomics and precision medicine programs to internal business leaders and consumers. Sample initiatives include: the identification of fraud, waste, and abuse and the associated impact, the modeling of business cases for advancement of genomic testing and analyzing the expected financial impact of potential new or revised clinical strategies. This individual will have the opportunity to partner with business leads to drive execution of identified cost savings and revenue capture opportunities.
This role is also responsible for value measurement oversight for all implemented women's health and genomics programs, ensuring clinical outcome measurement, and sustainable growth and business impact for initiatives delivered under the team's strategies.You will need to be motivated by a desire to optimize CVS Health resources to support improved health outcomes that drive business results. As the work is highly innovative and dependent on business partner alignment, you will be expected to continuously adapt as needs require and be comfortable navigating ambiguity in a cross-functional, matrixed setting. In addition, you will be required to independently manage complex projects and effectively communicate with internal and external stakeholders to support their progress, and project continuity and execution. As well as be proactive, creative, and nimble in your approach to enable success in a fast-paced and dynamic environment.This is a remote, home-based position in the US. If local to the corporate office in Woonsocket, RI, this will be a hybrid position.ESSENTIAL RESPONSIBILITIES
- Perform comprehensive analysis and clinical evaluation of genomic claims for compliance with relevant billing and processing guidelines and to identify opportunities for fraud and abuse prevention and control
- Work closely with all functional areas including the Special Investigative Unit and Payment Integrity to identify and implement quality and economic initiatives to manage fraud and abuse
- Serve as a subject matter expert providing clinical support to utilization management, clinical policy, and claims/coding teams toward reviewing genetic testing claims and appeals/grievances
- Leverage clinical knowledge and industry experience to identify, and support implementation and operational needs of innovative products and programs ensuring access and affordability
- Utilize data analytics, AI, competitive analyses, market research, expert interviews, observations, and pilot data to confirm business case opportunities for targeted interventions and business growth opportunity
- Drive early-stage new product definition and value proposition activities with key-stakeholders for genomic and precision medicine products and services
- Design and manage value measurement capabilities for the women's health and genomics team, supporting evaluation of front-end KPIs and reporting structures necessary to capture value. Maintain reporting and identify areas of improvement and scalability.
- 8-10 years of experience, with at least 4 years clinical experience in genetics or related specialty health area and 4 years of leadership experience in the healthcare, insurance, molecular diagnostics', biotech or pharmaceutical space with focus on genomics and/or women's health clinical programs, products and/or initiatives
- Expertise in clinical genetics and diagnostic genetic testing
- Experience using Microsoft Excel or other data tools to extract and analyze medical claims
- Proficient at health care data analysis and ability to use data to develop and present meaningful information
- Demonstrated understanding of health plan structures (preferably, commercial and government payers), payer medical and reimbursement policies, and ability to interpret clinical coding and reimbursement insights, particularly from lab/molecular test claims
- Excellent communication, negotiation, and presentation skills
- Demonstrated ability to develop programs and products within a payer environment
- Self-starter with the ability to work independently
- Demonstrated leadership in driving successful programs across teams in a matrixed environment
- Proficient in Word, Excel, and PowerPoint
Experience working for a national health plan
Self starter
Education
- Master's degree in genetic counseling or a Master's degree or higher in a health-related field with equivalent clinical and payer experience
- ABGC Board Certified (for a genetic counselor)
The typical pay range for this role is:$100,000.00 - $231,540.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program.Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.