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Vice President, Government Services Operations

Company: CVS Pharmacy
Location: Scottsdale
Posted on: September 13, 2020

Job Description:

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Vice President, Government Services Operations

Vice President, Government Services Operations Vice President, Government Services Operations

Job ID:

1352215BR

Location:

AZ - Scottsdale|TX - Richardson|PA - Pittsburgh|OH - Solon|TX - Irving

Street Address:

9501 E Shea Blvd

Category:

Job Description

The Vice President, Government Services Operations will be responsible for leading all aspects of the operation for PBM delegated clients with a heavy focus on service excellence and compliance on behalf of our clients and members. This leader is accountable for Coverage Determinations and Appeals (CD&D), CTM/Grievances, Innovations, Claims Monitoring, Reporting and Enrollment Operations. The leader will have 6 direct reports with over 1,200 colleagues across multiple locations with a robust work from home program. This executive will be responsible for driving productivity, quality, and colleague development across their organization. The encumbent must have critical thinking skills and superior problem solving capabilities to root cause and propose possible enterprise solutions to meet business needs. They will operate with a high level of flexibility to meet the demands of the organization. The Vice President is accountable for all operational outcomes, colleague and team development, and expected to collaborate with all peers and colleagues at all levels to ensure adoption with all new and existing client implementation and testing as well as readiness for audits and required reporting.

This leader will be expected to ensure outcomes and develop systems and processes that will enable CVSHealth to lead in this space and provide more clients with these services. Accountabilities include:

• Delivering at minimum a “significant quality improvement” rating versus prior year results

• Implementing a flawless compliance strategy that fulfills all CMS regulatory requirements necessary to achieve zero observations, corrective actions (CARs) or immediate corrective actions (ICARs) on CMS Program Audits

• Implementing a quality member response strategy that (i.) addresses beneficiary concerns, (ii.) fulfills CMS timeliness requirements, and (iii.) CMS response requirements

• Influencing cross-functional business unit leaders to implement process or execution improvement strategies that enhance the beneficiary experience and reduce the number of formal complaints filed as grievances or submitted to CMS as CTMs

• Establishing a client growth strategy to expand services to additional Medicare D clients

• Managing client relationships and all contractual obligations to exceed beneficiary experience expectations, avoid service warranties and any performance guarantees

• Effectively managing a cost center budget that exceeds $8.5 million in payroll and expenses

• Interacts with CMS Regional and Central Office officials to resolve critical/escalated beneficiary issues and provide feedback that ultimately influences future regulatory and guidance changes

• Delivering on all contractual obligations to exceed client expectations, avoid service warranties and any performance guarantees

• Identifying and implementing strategies to reduce waste, drive productivity and mitigate risk via technical innovation and data delivery

• Establishing the strategic direction and tactical plans for the department, ensuring consistency with the broader vision set by senior leadership

• Driving continual refinement, efficiency and automation into Member Services operational processes

• Collaborating to drive upstream process improvement to reduce negative member events and continual proactive identification of risk in the claims adjudication process with respect to clinical, benefit and regulatory facets

• Driving and developing centralized data structure and data acquisition strategies to support reporting needs

• Developing tools that reduce manual processes, mitigate risk and reduce inefficiencies allowing for more meaningful and focused work to be completed

• Partnering with IT to manage the maintenance, reliability, and functionality of all systems systems resulting in an uptime standard of 99.5% or greater

• Partner with IT to develop a roadmap for a Clinical System that will effectively integrate with Commercial Prior Authorizations to drive greater synergies across the Member Services clinical organization and ensure all platform consolidation exercises meet CMS regulatory and compliance requirements

• Consultative responsibility to both internal business partners and PBM clients to provide technology strategies and/or interface solutions

Required Qualifications

Autonomous individual with experience in pharmacy, pharmacy management, formulary management, drug utilization, managed care pharmacy, pharmacy benefit management, and third party (benefit) administration.

• Superior leadership, organizational, and prioritization skills.

• Demonstrates resourcefulness in problem-solving

• Displays confidence in the ability to learn complex material

• Demonstrates intellectual curiosity through inquiries to deliver accurate results

• Effectively interact with peers and other colleagues at all levels of an organization to positively impact joint activities, projects or events; utilize active listening skills and develop rapport with internal and external customers

• Excellent verbal and written communication and interpersonal skills w/ability to maintain patient confidentiality and present to peers, personnel of all levels, and Clients

• Proven leadership and staff development

• Proactively identify areas of need and independently craft and implement solutions to meet departmental and organizational goals and objectives

• Ability to read, analyze and interpret general business correspondence, technical procedures and governmental regulations

• Strategic, innovative individual with sound technical and analytical abilities, political savvy, and strategic thinking with over five years of experience in progressive leadership roles, with track record of delivering results while building high performing team

Preferred Qualifications

Experience or familiarity with Medicare Part D CMS guidance and various operational support systems, i.e. enrollment, call center, adjudication, and coverage determinations

Education

Bachelors Degree required, MBA preferred

Business Overview

At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

We are committed to a workplace that supports diversity, inclusion and belonging. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT.

Please note that we only accept applications for employment via this site. We provide reasonable accommodations to individuals with disabilities. To request an accommodation, including a qualified interpreter, written information in other formats, translation or other services, please email AdviceandCounsel@cvshealth.com or call 877-805-9511.If technical issues are preventing you from applying to a position, contact Kenexa Helpdesk at 1-855-338-5609 or cvshealthsupport@us.ibm.com . For technical issues with the Virtual Job Tryout, contact the Modern Hire Help Desk at 1-877-451-1695 or cvs_support@modernhire.com .The health and safety of our employees, patients, customers, and members is our top priority as we face the impact of COVID-19 together. We encourage you to visit our COVID-19 resource center at  https://cvshealth.com/covid-19  to learn more. Please be aware that CVS Health does not will never solicit money or offer payment for job applications, nor do we ask candidates to email or submit any personal information over unsecured channels. To learn more, please visit  https://jobs.cvshealth.com/FAQ .

Changing the future of health care at CVS Health

It's a New Day in Health Care at CVS Health

About CVS Health At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status.

Keywords: CVS Pharmacy, Scottsdale , Vice President, Government Services Operations, Other , Scottsdale, Arizona

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