Jobing.com, LLC.
Network Management - Manager (Individual Contributor)
Jobing.com, LLC., Scottsdale, Arizona, us, 85261
Job DescriptionThe Network Regulatory Compliance & Client Support Advisor will provide dedicated client support for assigned Commercial, Medicare, and Medicaid plans. The incumbent will demonstrate the ability to manage and administer multiple priority client requests. The individual will provide direct information tied to CVS Health PBM network-related products to assist CVS Clients with network strategy and to resolve challenges that may arise. The Advisor will support or manage flawless implementations of such products and/or provide oversight, including serving as a subject matter expert for Commercial, Medicare, and Medicaid-related regulations pertaining to pharmacy network.
In addition, this individual will serve as a subject matter expert for guidance and regulations; and drive implementation and/or process improvement to ensure CVS/caremark is compliant with present and future regulations that impact the pharmacy network division. The Advisor will collaborate with key functional leaders to implement regulatory requirements into business processes, initiate system enhancements needed to meet the regulatory requirements, and when necessary, identify and escalate associated business risks/impacts to Senior Pharmacy Network Leadership. The incumbent must understand Local, State, and Federal regulations end-to-end processes at CVS Health.
The position will focus primarily on Member and Pharmacy Network impacts but could expand into other business areas as regulations and the responsibilities associated with the position and the division evolve. The Advisor will ensure that Health Plans and CVS Health are compliant and will collaborate with internal partners to implement requirements into business processes. The position will initially support a set of CVS Health Clients but may expand to include other clients and/or health plans over time.
In this role, the incumbent will act as the primary client contact and liaison with other Network (Geo, Network Enrollment, Client Pricing) or PBM teams (Legal, Sales, Regulatory) as needed to resolve open issues, contribute to project plans, and provide required reporting (development and/or delivery of network-related reports).Pay RangeThe typical pay range for this role is:Minimum: 60,300Maximum: 126,600Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required QualificationsFive to seven years of experience required either working for a Health Plan or a PBM. Previous experience in successfully leading and/or managing a diverse group of direct and/or indirect team members to meet commitments.Preferred QualificationsExperience with Account Management and interaction with the Client, Health Plans, and/or MCOs. Experience with State Agencies. Experience with formal presentations, including best and final presentations, is desired. Knowledge of Client, MCO, State Model, and Health Plan contacts is desired. Knowledge of Local, State, and Federal Regulations is desired. Experience with Pricing, RFIs, and RFPs. Experience with working with large data sets and assimilating data and models efficiently. Experience with managing multiple complex and priority projects with short deadlines. Excellent written and oral communication skills. Excellent negotiation and problem-solving skills. Extremely comfortable working under pressure in a large matrix enterprise. Knowledge of RxClaim and claims research is preferred. Project plan experience is desired.EducationBachelor's degree required. An equivalent combination of education and experience may substitute.Business OverviewBring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to delivering enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient, and affordable. We strive to promote and sustain a culture of diversity, inclusion, and belonging every day. CVS Health is an affirmative action employer and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists, and National Guard) as well as military spouses to apply for CVS Health job opportunities.Apply
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In addition, this individual will serve as a subject matter expert for guidance and regulations; and drive implementation and/or process improvement to ensure CVS/caremark is compliant with present and future regulations that impact the pharmacy network division. The Advisor will collaborate with key functional leaders to implement regulatory requirements into business processes, initiate system enhancements needed to meet the regulatory requirements, and when necessary, identify and escalate associated business risks/impacts to Senior Pharmacy Network Leadership. The incumbent must understand Local, State, and Federal regulations end-to-end processes at CVS Health.
The position will focus primarily on Member and Pharmacy Network impacts but could expand into other business areas as regulations and the responsibilities associated with the position and the division evolve. The Advisor will ensure that Health Plans and CVS Health are compliant and will collaborate with internal partners to implement requirements into business processes. The position will initially support a set of CVS Health Clients but may expand to include other clients and/or health plans over time.
In this role, the incumbent will act as the primary client contact and liaison with other Network (Geo, Network Enrollment, Client Pricing) or PBM teams (Legal, Sales, Regulatory) as needed to resolve open issues, contribute to project plans, and provide required reporting (development and/or delivery of network-related reports).Pay RangeThe typical pay range for this role is:Minimum: 60,300Maximum: 126,600Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required QualificationsFive to seven years of experience required either working for a Health Plan or a PBM. Previous experience in successfully leading and/or managing a diverse group of direct and/or indirect team members to meet commitments.Preferred QualificationsExperience with Account Management and interaction with the Client, Health Plans, and/or MCOs. Experience with State Agencies. Experience with formal presentations, including best and final presentations, is desired. Knowledge of Client, MCO, State Model, and Health Plan contacts is desired. Knowledge of Local, State, and Federal Regulations is desired. Experience with Pricing, RFIs, and RFPs. Experience with working with large data sets and assimilating data and models efficiently. Experience with managing multiple complex and priority projects with short deadlines. Excellent written and oral communication skills. Excellent negotiation and problem-solving skills. Extremely comfortable working under pressure in a large matrix enterprise. Knowledge of RxClaim and claims research is preferred. Project plan experience is desired.EducationBachelor's degree required. An equivalent combination of education and experience may substitute.Business OverviewBring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to delivering enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient, and affordable. We strive to promote and sustain a culture of diversity, inclusion, and belonging every day. CVS Health is an affirmative action employer and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists, and National Guard) as well as military spouses to apply for CVS Health job opportunities.Apply
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