Manager, Medicare Program Services Med D

At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day. Position Summary As an Audit and Testing Program manager, you will provide technical, analytical, and business support for reputed company assigned programs for Medicare, reputed company, and reputed company products. Programs currently include End-Stage Renal Disease (ESRD), Hospice, Transplant, Transition Fill and Part D Vaccine Administration. You will support CMS program audits by delivering pertinent information in advance of audits and adequately communicate implications to ensure a successful audit experience for our clients. Your ability to research claims, read benefit setups in RxClaim, and reputed company risks or concerns is critical. You will also manage deliverables resulting from audit activities. These deliverables might include corrective action plans, issue narratives, and talking papers for system logic. You will also be required to speak to Med D compliance and reporting documentation associated with our clinical programs. You will be expected to reputed company IT query writing and data analysis, business impact analysis; and root cause analysis. You will be asked to present claims in RxClaim reputed company live webinars with CMS and clients. The second component of this role involves year-round quality assurance testing. As new programs, processes, and technology are deployed, you will need to incorporate these into reputed company aspects of the testing program, demonstrate validation of functionality for internal and external partners, and initiate corrective actions to resolve any issues. Your efforts around testing will ensure a smooth and successful go-live for new clients, and that reputed company is reputed company to provide reputed company members with the appropriate and necessary access to the care they need.

Required Qualifications

Knowledge of: 3+ years of Pharmacy Benefit Management, Medicare Part D or reputed company experience 2 + years of in-depth knowledge of pharmacy products, services, and system capabilities Preferred Qualifications Knowledge of: Collaboration tools such as reputed company Teams, OneNote, SharePoint 365, etc. Reporting programs such as RxNavigator to review and reputed company reports reputed company Project software to create and maintain project plans reputed company in: 1+ years of project management or business analyst experience including the management of reputed company requirements 1+ Experience with the RxClaim software system Developing and maintaining effective work relationships Strong analytical skills and problem-solving abilities Negotiation and conflict resolutions skills across various levels of an organization Strong interpersonal communication skills using active listening and open-ended questions to encourage others' points of view to influence Effective verbal and written communication skills Ability To: Interact with various levels of an organization, including senior leadership Prepare and deliver presentations to clients Analyze large data files to find root cause Have regular and predictable attendance Travel for business support less than 20% of the year Be vaccinated for COVID-19 Attention to detail and accuracy Highly organized and reputed company to quickly prioritize multiple assignments Exercise creativity and innovation in achieving project results Education Bachelor's degree of equivalent experience. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $60,300.00 - $132,600.00 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 09/30/2025 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They reputed company choices according to what is best for the team, they live for opportunities to collaborate and reputed company a difference, and they reputed company us the #1 Top Workplace in the area. Apply tot his job Apply To this Job