Medicare Pharmacy Audit Programs Project Manager
Medicare Pharmacy Audit Programs Project Manager
Employer Active
Job Alert
You will be updated with latest job alerts via email
Share
Job Alert
You will be updated with latest job alerts via email
$ 60300 - 132600
1 Vacancy
Job Description
At CVS Health were building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nations leading health solutions company we reach millions of Americans through our local presence digital channels and more than 300000 purposedriven 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 the Medicare Pharmacy Audit Programs Project Manager you will be responsible for administering Medicare PartD Pharmacy Audit Programs. In this role you will be expected to familiarize yourself with all the Medicare Audit Programs and become a subjectmatterexpert on assigned audit programs. As new CMS guidance is released each year you will be expected to develop solutions to flexibly adapt the Medicare Audit Programs to comply with the new requirements and new programs. You must utilize critical thinking skills to make businesscritical decisions and develop strategies to maximize client compliance will utilize a wide variety of skills and technological resources to assist in this task and will develop new processes and systems along the way through claim and trending investigation and analytics.
Some key responsibilities:
- Developing new Audit Programs and enhancing current ones.
- Administering Audit Programs including oversight of the audit process and architecture.
- Conducting pharmacy outreach collaborating with internal team members to accomplish your goals.
- Analyzing and summarizing audit results using SQL coding analytics.
- Coordinating the correction of Medicare PartD claims and PDEs
These audit programs help keep CVS Health plans in compliance with CMS requirements and maintain positive STAR ratings. As part of this you will also be responsible for reviewing and interpreting CMS guidance. You will also be responsible for coaching mentoring and developing staff auditors to enhance the process efficiency of our services. You will be required to work independently within a team philosophy and collaborate directly with both internal partners and external clients.
Required Qualifications
- 5 or more years Project Management experience
Preferred Qualifications
- Thorough knowledge of PBM and pharmacy industry
- Proficiency in software applications including Microsoft Office suite Microsoft Excel Microsoft Access SQL coding Teradata RxClaim Salesforce Sharepoint.
- Nationally Certified Pharmacy Technician (PTCB)
- Experience in Medicare PartD pharmacy audit programs
- Experience using SQL code to query and analyze database systemsExperience conducting pharmacy audits
- Excellent teamwork and collaboration abilities
- Selfdriven
- Experience in process or project management
- Ability to work under pressure to meet critical deadlines
Education
- Bachelors Degree or relevant work experience required
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$60300.00 $132600.00This pay range represents the base hourly rate or base annual fulltime salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience education geography and other relevant factors. This position is eligible for a CVS Health bonus commission or shortterm incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers patients members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in our comprehensive and competitive mix of pay and benefits investing in the physical emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages our great benefits include:
Affordable medical plan options a 401(k) plan (including matching company contributions) and an employee stock purchase plan.
Nocost 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.
For more information visit anticipate the application window for this opening will close on: 06/14/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal state and local laws.
Required Experience:
IC
Employment Type
Full-Time
