Job Description The Health Plan Benefits Operations Director leads approximately 50 colleagues and 30 contractors in implementing and maintaining pharmacy benefits for Health Plan Government clients across the Medicare, Medicaid, and Exchange lines of business. The Director is responsible for three functional areas: benefits requirements, configuration, and testing. The Director is responsible defining the strategic direction for the team to achieve business and regulatory objectives with a strong focus on continuously improving quality while efficiently scaling services using automation.
The Director is responsible working directly with senior leaders across Account Management, Sales, IT, Clinical, Internal Audit, Medical Affairs, and Government Operations and our clients to ensure service expectations are being achieved year over year.
Responsibilities: â¢ Defines strategies to improve the implementation and maintenance of plan benefits for Health Plan Government clients. Leads team in the execution of the strategies. â¢ Builds a high-performing team by providing opportunities, guidance, and feedback to develop colleagues and ensure a pipeline of talent for the future growth. â¢ Lead process improvements initiatives across requirements, configuration, and testing to improve quality and increase team efficiency. â¢ Ensures teamâ™s critical metrics, strategic projects, and compliance objectives are achieved by team. â¢ Partners with Senior Leaders across Account Management, Sales, Clinical, IT, Internal Audit, Medical Affairs, and Government Operations to ensure client expectations are accurately being set and achieved. Engages with clients to ensure expectations are being met.
Required Qualifications â¢ 5 + years of Experience in the healthcare industry with in-depth knowledge of pharmacy benefits management operations for Medicare, Medicaid, and Exchange is preferred â¢ Ability to travel up to 25% of the time
Preferred Qualifications â¢ Experience in the healthcare industry with in-depth knowledge of pharmacy benefits management operations for Medicare, Medicaid, and Exchange is preferred. â¢ Good communicator, both verbal and written, with executive presence and the ability to influence across functions and at all levels of an organization. â¢ Highly organized and able to provide positive leadership across multiple work streams in a fast-paced, matrixed working environment. â¢ Ability to handle multiple and often challenging priorities. â¢ Ability to think both strategically and tactically along with a willingness to challenge the status quo to ensure the department reaches higher levels of performance â¢ Consulting, Project Management and/or Implementation Experience â¢ Experience developing, measuring, monitoring, and driving improvement in New Client Implementations Key Performance Indicators â¢ Solid understanding and experience with healthcare products including formulary, utilization management and accumulations
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.
Internal Number: 1594278BR
About CVS Health
Combining CVS Health and Aetna was a transformative moment for our company and our industry, establishing CVS Health as the nation’s premier health innovation company. Through our health services, insurance plans and community pharmacists, we’re pioneering a bold new approach to total health. As a CVS Health colleague, you’ll be at the center of it all.
At CVS Health, we work every day to help people on their path to better health. Never has it been more important for us to deliver on our purpose to our valued customers, patients, members, and employees. With a presence in communities across the country, CVS Health colleagues are and will continue to be a critical piece of the country’s health care solution. The health and safety of our employees, patients, customers, and members is our top priority as we face the impact of COVID-19 together. If you would like to learn about the actions we are taking as a company as we learn more about COVID-19 and its spread, we encourage you to visit our COVID-19 resource center at https://cvshealth.com/covid-19
We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to... attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability.
CVS Health is an equal opportunity/affirmative action employer. Gender/Ethnicity/Disability/Protected Veteran – we highly value and are committed to all forms of diversity in the workplace. 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 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.
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