The Network Regulatory Compliance & Client Support Advisor will provide dedicated client support for assigned Commercial, Medicare and Medicaid plans. The incumbent will demonstrate ability to manage and administer the 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/impacted 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 on primarily 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 Heath 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 to provide required reporting (development and/or delivery of network related reports).
The typical pay range for this role is:
Please 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.
Five 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.
Experience 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 communications skills. Excellent negotiation and problem-solving skills. Extremely comfortable working under pressure is a large matrix enterprise. Knowledge of RxClaim and claims research is preferred. Project plan experience desired.
Bachelor's degree required. An equivalent combination of education and experience may substitute.
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