Position Summary: The Pharmacy Management Analyst is primarily responsible for supporting operations and development within CVS/ Specialty’s medical claims engine (Novologix). The Pharmacy Management Analyst will be responsible for the maintenance and implementation of the claim engine’s various service offerings and the support of current clients. In addition, the Pharmacy Management Analyst will support the drug claim review process including manual drug review, reporting, interaction with payers and providers, drug claim holds and rejects, and automated drug review rules development and maintenance. The position also has cross-functional responsibility to support and/or participate in the activities of other departments within CVS Health.
Additional responsibilities of the Pharmacy Management Analyst include:
- Supports business operations and client implementations in the development and maintenance of prior authorization criteria, fee schedules, client set-ups, and clinical edits within the Novologix system.
- Support client implementations through development and implementation of client specific operational requirements.
- Develops knowledge of drug database and assists with questions and processes related to drug database, NDC/HCPCS crosswalk and drug pricing calculations and loads.
- Performs daily drug claim review and assists in resolving related issues, performing related reports, and conducting routine claim rejection process. Accesses internal and external databases and sources (providers) to obtain needed information.
- Monitors the Pharmacy and Drug Review incidents and facilitates the resolution of incidents related to drug and miscellaneous code claim review. Required Qualifications: - 2+ years’ experience in a working environment that requires knowledge of Pharmaceuticals, Infusion Products, and Medical Terminology
- 2+ years of demonstrated ability to work independently and manage multiple projects Preferred Qualifications: - Experience working within an IT environment
- Skill in analyzing data and reports and generating recommendations for process change.
- Ability to communicate effectively with internal and external stakeholders.
- Ability to make timely and sound decisions based on adequate information
- Ability to identify and use appropriate resources and knowledge to solve problems and resolve issues.
- Ability to identify, document, and implement effective processes and procedures for accomplishing work
- Moderate to Advanced user of Microsoft Office Suite (Word, Excel, and Outlook)
- Pharmacy experience preferred Education: High School Diploma or GED required.
Bachelor’s Degree preferred.
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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CVS Health does not require nor expect that applicants disclose their compensation history during the application, interview, and hiring process.
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/