Medicare Appeals Vendor Program Manager

role is responsible for managing the relationship of the vendors and coordinating numerous tasks and projects that will drive overall performance. The Manager will also have direct accountability to add/edit new hires and support onboarding of vendor staff. The Manager will have direct accountability for service level performance, appeal quality, and , production metrics and partner with other vendor management and operational areas to support their designated areas of responsibility that aligns with the CVS Health model of putting our members first. The Manager must align and deliver on stakeholder and business performance. The Manager will participate in projects at the stakeholder level as assigned and will lead/facilitate the review and report out on vendor performance across all of Medicare Appeals.

This role requires business operational acumen to communicate effectively with both internal and external operational teams. The Manager is expected to evolve and improve vendor processes including but not limited to reviewing or recommending innovative solutions that will impact our clients and members, strategic planning, analysis of data, and overall operational performance of key deliverables. Managers will participate in projects that interlock with Vendors, business strategy, onboarding, and decommissioning of vendors as a Subject Matter Expert. The Manager will manage be involved in projects to ensure that vendors and CVS teams are engaged and have the necessary resources to complete tasks in a timely manner. There will be times when business owners within CVS Health need assistance understanding the vendor's setup and operations to ensure transparency and the ability to manage CVS Health's organizational business models.

Required Qualifications

• 6+ years Healthcare and/or PBM experience

• 4+ years C-level experience

• Regular and reliable attendance

• Colleague will be required to work mandatory overtime/extended work week when needed

• Advanced computer skills - Visio Professional, Word, PowerPoint, Outlook, Excel, TEAMs, WebEx Excellent communication skills, both written and verbal

• Willingness to collaborate with CVS/Aetna/Vendor IT and Operational, plus the many teams involved internally and externally

• Must be able to work independently with all levels and in every area of the OrganizationVendor/outsourcing knowledge

Preferred Qualifications

• Deep understating of Medicare Appeals/Healthcare Business

• Understanding of Resource Planning Operations

• Operational Health Care industry knowledge

• 3+ years of Management experience

• Knowledge of 5 why's methodology of root cause analysis

Education

Bachelor's Degree or equivalent work experience

Pay Range

The typical pay range for this role is:

$60,300.00 - $159,120.00

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.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 09/21/2024

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