Pharmacy Operations Senior Manager
CVS Pharmacy - Pittsburgh, PA
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Job DescriptionThe Pharmacy Operations Senior Manager is accountable for providing operational support around excellence, quality assurance and compliance for the Medicare Operations organization. You will be responsible for leading and directing a diverse team to promote innovative outcomes related to achieving service and financial performance, customer satisfaction, quality, and compliance of our workforce. You must be able to combine your clinical expertise along with technical skills to lead a team in solving complex problems. You will be a vital contributor to improvements in systems reliability, workflow, productivity, cost, and quality. You will also be involved in planning, design, and execution of key projects. The Senior Manager is responsible for ensuring clear, consistent processes are defined to drive change management, system maintenance, and long-term strategic projects. You will drive recommendations for improvements that better position the organization to support/anticipate market changes, and be an active collaborator in the implementation, compliance, delivery, and execution of these recommendations. The Senior Manager will have a small team of direct reports with oversight of support staff across work from home locations. The successful candidate must have critical thinking skills and superior problem-solving capabilities to root cause and pursue possible solutions. You will operate with a high level of flexibility to meet the demands of a production environment, regulatory/accreditation landscape, and system customization. The Senior Manager is accountable for financial, regulatory, and operational outcomes, colleague, and team development, and expected to collaborate with peers and colleagues at all levels.Additionally, the Senior Manager will review clinical coverage determination and appeal requests as a licensed pharmacist (per state requirements), in accordance with CMS guidance, which states only a pharmacist can deny a coverage determination for Medicare Part D beneficiaries.Required Qualifications- Minimum 5 years of leadership experience- 3 years of PBM experience specifically with knowledge of utilization management- Medicare Part B and Part D knowledge- Computer knowledge including Microsoft office products, Windows based operations, data entry and clinical systemsCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred QualificationsFamiliarity with MedHOK, CAS, and Novologix PA processing systemsEducationBachelor's degree in Pharmacy required, PharmD preferredBusiness OverviewBring your heart to CVS HealthEvery 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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. 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.
Created: 2024-09-07