The Senior Advisor, Clinical Client Operations will be responsible for Enterprise RxClaim users on various projects, initiatives, and client requests related to Prior Authorizations to provide flawless experience to our customers and pharmacies. Conduct complex data analysis on large datasets and databases. Analyze findings and present results to CVS Health internal and external business partners to make informed strategic business decisions. Collaborate with various organizations and business partners to design inter-system interactions and implement PA processes that will span multiple technology systems ensuring that end to end process execution is flawless and error free. Perform complex root-cause analysis on issues faced by business and identify impact to health care members and clients in accordance with CMS guidance. Identify business requirements and provide solutions by assisting in automation to current technology and processes. Evaluate an assigned process or technology and processes. Evaluate an assigned process or technology and make recommendations to solve CVS Health or department business concerns. Utilize her Prior Authorization subject matter expertise to help the team implement, monitor and measure the quality of Prior Authorization overrides for various points of entry. Assist department customers to become knowledgeable and proficient in executing Prior Authorization overrides for various points of entry. Serve as a leader for various initiative and take the lead in PA related discussions or actions items related to cost savings. Develop and implement processes and tools to achieve established team goals. Develop and implement processes and tools to achieve established team goals and make professional presentations to CVS Health Senior Management. Provide weekly status and updates on projects to leadership and to escalate risks and issues as appropriate. Help define and maintain any department Policy and Procedures and Information Systems.
A Master's degree or foreign equivalent in Information Systems/Information Management Systems or a related quantitative field and 2 years of analytical skills experience working with large data sets for initiatives or trending opportunities. Must also have 2 years of experience in AS400 systems and SQL Server. Will accept a Bachelor's degree and 5 years of experience in lieu of a Master's degree and 2 years of experience. 10% Domestic Travel required. Telecommuting Available. Must apply by 7/24/2020.
Please see required qualifications.
A Master's degree or foreign equivalent in Information Systems/Information Management Systems or a related quantitative field. Please see required qualifications.
It's a new day in health care.
Combining CVS Health and Aetna was a transformative moment for our company and our industry, establishing CVS Health as the nation's premier health innovation company. Through our health services, insurance plans and community pharmacists, we're pioneering a bold new approach to total health. As a CVS Health colleague, you'll be at the center of it all.
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