Manager, Medicare Program Services Med D

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 Summary

As an Audit and Testing Program manager, you will provide technical, analytical, and business support for all assigned programs for Medicare, Medicaid, and Commercial products. Programs currently include End-Stage Renal Disease (ESRD), Hospice, Transplant, Transition Fill and Part D Vaccine Administration. You will support CMS program audits by delivering pertinent information in advance of audits and adequately communicate implications to ensure a successful audit experience for our clients. Your ability to research claims, read benefit setups in RxClaim, and articulate risks or concerns is critical. You will also manage deliverables resulting from audit activities. These deliverables might include corrective action plans, issue narratives, and talking papers for system logic. You will also be required to speak to Med D compliance and reporting documentation associated with our clinical programs. You will be expected to develop IT query writing and data analysis, business impact analysis; and root cause analysis. You will be asked to present claims in RxClaim via live webinars with CMS and clients.The second component of this role involves year-round quality assurance testing. As new programs, processes, and technology are deployed, you will need to incorporate these into all aspects of the testing program, demonstrate validation of functionality for internal and external partners, and initiate corrective actions to resolve any issues. Your efforts around testing will ensure a smooth and successful go-live for new clients, and that CVS is able to provide all members with the appropriate and necessary access to the care they need.Required Qualifications

Knowledge of:

• 3+ years of Pharmacy Benefit Management, Medicare Part D or Medicaid experience
• 2 + years of in-depth knowledge of pharmacy products, services, and system capabilities

• Collaboration tools such as Microsoft Teams, OneNote, SharePoint 365, etc.
• Reporting programs such as RxNavigator to review and develop reports
• Microsoft Project software to create and maintain project plans

• 1+ years of project management or business analyst experience including the management of complex requirements

• 1+ Experience with the RxClaim software system
• Developing and maintaining effective work relationships

• Strong analytical skills and problem-solving abilities
• Negotiation and conflict resolutions skills across various levels of an organization
• Strong interpersonal communication skills using active listening and open-ended questions to encourage others' points of view to influence
• Effective verbal and written communication skills

• Interact with various levels of an organization, including senior leadership

• Prepare and deliver presentations to clients
• Analyze large data files to find root cause
• Have regular and predictable attendance
• Travel for business support less than 20% of the year
• Be vaccinated for COVID-19

• Attention to detail and accuracy
• Highly organized and able to quickly prioritize multiple assignments
• Exercise creativity and innovation in achieving project results

• 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.