At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven 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 Part-D Pharmacy Audit Programs. In this role, you will be expected to familiarize yourself with all the Medicare Audit Programs and become a subject-matter-expert 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 business-critical decisions and develop strategies to maximize client compliance integrity. You 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 Part-D 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 Part-D pharmacy audit programs
• Experience using SQL code to query and analyze database systems-Experience conducting pharmacy audits
• Excellent teamwork and collaboration abilities
• Self-driven
• Experience in process or project management
• Ability to work under pressure to meet critical deadlines

Education

• Bachelor's Degree or relevant work experience required

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time 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 short-term 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.

• No-cost 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 https://jobs.cvshealth.com/us/en/benefits

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.