Manager, Clinical Quality

Job DescriptionLeads multiple, concurrent projects with a focus on regulatory exams. Responsibilities include, but are not limited to, providing support to manage requests for information made in connection with regulatory exams, preparing and submitting responses to such requests, partnering with business, compliance and other team members, establishing and maintaining contacts with regulatory examiners and/or Client's designated exam coordinators to ensure facilitation of the examinations. Work in partnership with compliance and business teams to address findings and corrective action plans and to facilitate resolution of the examinations. Review exam notices and coordinate with appropriate business partners to obtain required data elements Provide responses to examiner requests Assess exam findings, assist with development of company position statements, and coordinate cross-functionally to develop corrective actions Provide colleagues guidance on claim questions specific to self-funded claim audits Lead third party self-funded claim and financial audits, as needed Assist with special projects, as neededPay RangeThe typical pay range for this role is:Minimum: 60,300Maximum: 126,600Please 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.Required Qualifications Minimum of 5 years audit, compliance or regulatory project management experience within health insurance or related field Experience working with regulatory examiners or external audit firms Proficiency with Microsoft Office Suite (i.e. Word, Excel, PowerPoint) Superior verbal/written communication and interpersonal skills Excellent time management skills in deadline driven environment Ability to work and make decisions independentlyPreferred Qualifications Knowledge of the DG system Claims processing experienceEducationBachelor's degree or equivalent experienceBusiness 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: 2024-10-19