Position Summary:Oversees a team of pharmacists and technicians whose primary function is processing requests for coverage determinations and appeals under the Med D program. The supervisor participates in the interviewing and hiring process and manages the training track for new team members. Overall personnel management of the team includes writing and conducting semi-annual and annual performance reviews, providing ongoing coaching, and career management. The supervisor is also responsible for issue escalations requiring management support, monitoring work queues in MedHOK and participating in daily operations conference calls. The supervisor is responsible for driving productivity, monitoring quality assurance and managing staffing to queue volumes. The supervisor will be responsible for balancing staffing to the case volumes in the active work queues against the inbound call volumes. The supervisor must have a thorough working knowledge of CMS Chapter 18 and ensure that all requests for coverage are processed in accordance with the requirements of Chapter 18, client specific requirements and/or CVS Caremark policies. The supervisor must understand the appeals process from end-to-end and assist in meeting client’s expectations regarding efficiency, service levels, privacy maintenance and quality of decision-making. The supervisor will also be responsible for reviewing medication exception requests, as well as completing data analysis and various clinical projects. This position will require analysis of quality errors, coaching users regarding the errors, providing timely feedback and follow up for errors, tracking and trending of errors, and managing users thru the performance improvement process. This individual must maintain a client–centric approach to resolving client issues and requests. Serve as a subject matter expert for multiple processes, skill sets, and all internal work instructions. Participate and lead project teams to improve business unit performance as required by CD&A leadership. Manage time to effectively coach and mentor pharmacists, technician supervisors, technicians and reps in their skill segments as needed. The supervisor will provide performance feedback on an ongoing basis to all team members. They must develop and demonstrate leadership qualities and serve as backup in absence of the manager. Drive team performance and results to achieve daily individual and team productivity goals. Identify areas of improvement within all work processes to decrease risk to the organization and improve client satisfaction. Provide consultative support, offering solutions and alternatives to client case processing questions from account management team and team members. Assist team members in researching any case processing issues and coach individuals to develop recommendations and alternative solutions for internal partners in meeting client needs. Successfully engage internal business partners, SME’s and leaders as needed to resolve issues, drive results and meet time limitations as required by client requests. Provide follow thru and follow up as required for high-profile client coverage determination issues. Interface with internal partners and external clients via conference calls and written communication as required. The supervisor will work with CD&A management and leadership to provide trends and metrics to ensure the success of the team and transition to any new processes. The supervisor will also manage individual internal projects from time to time and be expected to report and effectively communicate to senior leadership. There is a potential for travel 1-2 times per year.
Required Qualifications:Valid Pharmacist license or ability to obtain license and a PharmD degree or foreign equivalent, 2 years of leadership experience, and 2 years of experience working with PBM Medicare Part D; Managed Care in a PBM environment; CMS regulations; MedHOK; RxClaim; and RxSource required. Will accept a Bachelor’s degree in pharmacy and 5 years of experience in lieu of a PharmD degree and 2 years of experience. Must apply by 11/02/17.
Preferred Qualifications:Please see required qualifications.
Education:Valid Pharmacist license or ability to obtain license and a PharmD degree or foreign equivalent, 2 years of leadership
experience. Will accept a Bachelor’s degree in pharmacy and 5 years of experience in lieu of a PharmD degree and 2 years of experience. 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.
CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law. CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW
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For inquiries related to the application process or technical issues please contact the Kenexa Helpdesk at 1-855-338-5609. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352. Please note that we only accept resumes via our corporate website: https://jobs.cvshealth.com/
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