The Network Quality – Senior Consultant position will be working on the quality team responsible for quality assurance reviews of our client and pharmacy pricing, and claims adjudication system setups at CVS Health, a top ten Fortune company.
Using past experience, you will utilize various technical options for data mining and analysis, coupled with providing technical solutions and tools using SQL, MS Access, MS Excel, various query building methodologies (e.g. AS400), etc. to expand our data management and quality analysis needs.
The Network Quality – Senior Consultant should be able to translate information to varying levels of subject matter expertise (e.g. Leadership, IT, Account Teams, etc.) and maintain compliance for our audit-able processes. Employing strong interpersonal skills, the individual will also work with Department Leaders to identify training and mentoring opportunities in areas of technical growth.
You will also help triage issues through root cause analysis and provide recommendations for remediation. Be deadline focused and able to make decisions quickly and efficiently while working in a team and environment as a self-starter.Required Qualifications:
- 2+ years of healthcare experience
- 2+ years of MS Office experiencePreferred Qualifications:
- PBM or Health Care industry experience preferred, with knowledge of CVS Caremark network programs and procedures.
- Experience with RxClaim
- Proven experience with various query and reporting tools. RxClaim query, EDM, Sequel, SQL and SAS.
- Excellent planning and project management skills.
- Demonstrate ability to provide technical solutions to meet business needs.Education:
Verifiable High School diploma or GED is required. Bachelor's degree 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.
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
and EEO IS THE LAW SUPPLEMENT
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance to apply for this job, please contact us by clicking AA EEO CVS Health
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/