Our Ability Jobs

Bring 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 deliver 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.

Position Summary This is an advanced level program ownership position that will be responsible for providing strategic technology support and direction to the Novologix (NLX) Medicare Part B prior authorization operations management and leadership teams.

• Serve as a Novologix functional SME with a focus on delegated Medicare Part B.

• Develop, execute, and maintain project concepts that facilitate improvements for the NLX organization. This individual is responsible for providing guidance for prioritization of a complex portfolio of Medicare Part B initiatives in support of new or changing business objectives to ensure that the Novologix Product priorities and objectives are aligned with Medicare Part B Operational priorities and objectives.

• Responsible for appropriately identifying problems, challenges, risks and impacts for any change or enhancement being proposed and problem solving to ensure optimal Operational performance.

• Drive improvements through projects and technology, but also in collecting an understanding of best practices in the Medicare business unit and streamlining other business units to adopt these best practices.

• Provide Medicare Part B user experience subject matter expertise during project requirements and support use case development. Support planning of UAT strategy to define UAT best practices and maintenance of test case libraries for both functional and regression testing. This individual must indirectly lead others through both requirement and user story development, as well as test case execution by interacting with Operations, IT Development, IT Support, IT Project Management, Product Development, Account Management, and other organizations.

• Coordinate problem analysis, solution validation, risk management, issue resolution/escalation, communication, and stakeholder engagement for all technology initiatives. Responsible for integration and coordination of changes across upstream Medicare product and IT teams and downstream operational teams.

• Work closely with stakeholders and business partners to drive enhancements including, Pharmacy Segment Services (PSS) Operations, IT Development, IT Support, IT Project Management, Product Development, Account Management, Finance, HR, Regulatory Affairs, Legal and other organizations. Interface and communicate directly with Senior and Executive leadership from all different areas of the company and interface heavily with IT development partners.

• Operate with a high level of flexibility to meet the demands of a production environment, regulatory/accreditation landscape, and client customization. The primary focus will be on the delegated Medicare lines of business and ensuring our technology supports the operational expense, client savings, and compliance goals. Must ensure compliance with all appropriate regulations – Federal and State, accreditation standards – URAC and NCQA, client requirements, and performance guarantees, especially as it relates to technology functionality.

Required QualificationsMinimum 3 years of experience working with Novologix

Minimum 3 years of experience with Medicare Part BPreferred Qualifications 6+ years of experience working with delegated Medicare Part B clients.

5+ years of experience working in the Novologix application. EducationAssociate's degree

Pay Range

The typical pay range for this role is:

$60,300.00 - $132,600.00

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: 05/22/2024

We are an equal opportunity and affirmative action employer. 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.