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Bring your heart to CVS Health. Every 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.

Position Summary

The Quality Assurance Consultant fulfills the company purpose of helping people on their path to better health by driving quality execution of PBM functional area performance. The Consultant will perform some monitoring activities. However, this position requires a higher level of analysis of monitoring results and a Consultant will interact and collaborate with internal colleagues and Business Partners to identify opportunities to improve monitoring methodologies, Operations processes, define those new methodologies and collaborate to develop recommended Operations Process changes and perform root cause analysis. The analysis will drive operational process review and revision, continuous improvement and help Operations reduce individual and departmental operational, regulatory, reputational, financial and legal risk.

The Quality Assurance department is responsible for monitoring the performance of individual business operations within the PBM that support all Government and Commercial market segments (Medicaid, Exchanges, Commercial, Aetna, Appeals, SGM/CRU, Pharmacy Advisor, Medication Therapy Counseling, Aetna Specialty Pre-Certification and the Health Insurance Marketplace). QA evaluates functional area performance using various techniques, standards and methodologies to validate compliance with government regulations, patient safety requirements, performance guarantees and internal processes and procedures. The role of QA in the organization is to identify emerging issues, monitor the effectiveness of controls and processes, and assist in developing process controls in partnership with the business to improve outcomes.

Required Qualifications Intermediate skills with spreadsheets and databases, including a strong working knowledge of MS Excel, MS Access and/or SQL databases Basic project management skills and experience leading peer team projects using basic project management techniques Demonstrated subject matter expertise in assigned line(s) of business Experience in providing subject matter expertise used to develop business requirements for reporting, data aggregation and analysis tied to business metrics and key performance indicators Demonstrated success dealing with ambiguity or uncertainty and ability to learn on the fly to understand and solve new problems Ability to demonstrate a high level of independent judgment and initiative Ability to communicate effectively, both verbally and in writing, in a manner that is clear, logical and consistent Excellent interpersonal skills, including the ability to interact with and influence peers and QA management Prior role in audit, compliance, data analytics and reporting and experience in Pharmacy Benefits Management (especially Medicaid, Exchanges, Commercial, Aetna, Appeals, SGM/CRU, Pharmacy Advisor, Medication Therapy Counseling, Aetna Specialty Pre-Certification and the Health Insurance Marketplace preferred)

Preferred Qualifications Prior role in audit, compliance, data analytics and reporting and experience in Pharmacy Benefits Management (especially Medicaid, Exchanges, Commercial, Aetna, Appeals, SGM/CRU, Pharmacy Advisor, Medication Therapy Counseling, Aetna Specialty Pre-Certification and the Health Insurance Marketplace preferred)EducationHigh School Diploma

Pay Range

The typical pay range for this role is:

$18.50 - $35.29

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 03/29/2024

CVS 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.

CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through ColleagueRelations@CVSHealth.com If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.

We are an equal opportunity and affirmative action employer. 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.