| Position Summary: As the Coverage Determinations and Appeals Operations Director of the Medicare Part D Coverage Determinations and Appeals (CDA) San Antonio Operations you will be a vital leader within the Government Services Division and the greater Pharmacy Benefit Management (PBM) business. |
You will have accountability for delivering financial, operational, compliance, and service excellence in Medicare Part D Coverage Determinations and Appeals.
Leading a team of direct and indirect reports (managers and supervisors of Pharmacists and Technicians) you will be responsible for the following:
1) Delivering results that are 100 percent compliant with Medicare Part D regulations and result in 5-Star performance for all delegated CDA plans 2) Providing service and operational excellence to clients, Medicare Part D beneficiaries, and their prescribers; 3) Meeting financial goals, including the successful and sustained implementation of cost reduction initiatives 4) Ensuring the team is well trained on all processes and procedures and has access to high quality instruction and reference materials 5) Consistently managing performance and developing the team at all level 6) Responding timely to CMS,client, or internal partners regarding inquiries, requests, or issues related to the CDA operation.
In addition, you will have sole accountability for the performance of the San Antonio CDA Operations team and shared accountability for CDA Operation-wide results. You will be evaluated on operation-wide results that include CMS Star measures, auto forwards, audit and compliance scores, turnaround times, and budget/financial metrics.
As the Director of the Medicare Part D Coverage Determinations and Appeals your ability to communicate effectively and succinctly with a diverse range of constituents, both verbally and on paper, with all levels of an organization, both internally and externally, will be paramount to your success.
Your unique ability to build and develop high-performing teams while balancing the needs of thee business with the needs of the customer will help to drive and grow the Medicare Part D business with CVS Health!
Required Qualifications: 5+ years of proven experience experience in a back office operations environment in healthcare operations within a PBM, pharmacy, or similar industry
Preferred Qualifications: 3+ years of experience with healthcare regulatory programs (Medicare or Medicaid)
Education: Bachelor's degree. Will consider a combination of education and years of relevant work experience. Pharm D or MBA preferred.
Business Overview: CVS Health, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units – MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.
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