Job Description
The supervisor is responsible for providing operational leadership and direction for Specialty Prior Authorization and Appeals business units with focus on the Prior Authorization piece. The position has a primary focus on ensuring compliance with all state, federal, and client regulations and accredidations. Other key areas of focus include coaching and mentoring CRU employees, including pharmacists and technicians; quality improvement; innovation and reduction of unit costs. Responsibilities of the position include daily operational oversight, staff development, budget management, audit readiness, staff training documentation and execution, and policy and procedure documentation. The leader will work with internal partners and the CRU staff to service physicians, pharmacists and patients within service level agreements. Responsibilities % Time1. Using the tools provided, monitor day-to-day staff/department activities and staff production to ensure department goals and SLAs are being met. 40%2. Leading the Case Review Unit ensuring the operational unit is complying with regulatory requirements and accredidation standards. 20%3. Establishes and maintains communication amongst CVS Caremark’s departments, clients, and deligates. 20%4. Participates in quality management activities on ongoing bases, including but not limited to work instructions, job aids, and quality monitoring. 10%5. Assist in handling escalated calls from physicians or members regarding the prior authorization process 5%6. Performs other related projects and duties as assigned 5%
Required Qualifications
COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions 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, pregnancy, or religious belief that prevents them from being vaccinated.
If you are 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 within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.
Preferred Qualifications
Bachelor degree, 5-8 years of prior/relevant work experience
Education
Active technician license in state of practice, preferred bachelor degree
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.
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