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Position Summary
The Analyst, Clinical Services is responsible for ensuring that any changes to Medicare Part D Coverage Determinations, Appeals, Organization Determination and CTM/GRV systems, processes, letters, workflow, and business change requests are appropriately completed. This is a key role to ensure that clients, members and internal colleagues have CMS compliant tools that allow for complete and accurate processing of CD&A cases. The Analyst may work with account teams, implementation managers, business requestors, and/or the UM Development/Medical Affairs teams to ensure that business intent is appropriately interpreted and then configured correctly and tested in the operating system. The Analyst must be able to research and solve complex problems, perform root cause analysis, provide feedback and solutions for meeting our project plans and monthly/quarterly release timelines. The Analyst is accountable for the process/task to be completed appropriately, consistent with the request intent, and on time.

Primary Duties & Responsibilities

1. Configuration and Self-Test of Med D CD&A Systems.

2. Deployment night Pre & Post Deployment Report Validations.

3. ServiceNow Ticket and Issue Research for CD&A, CTM/GRV Operations (7 days/week).

4. Case Assignment, Some Training/BSR/CMS/System Change Meetings.
Required Qualifications
Up to 3 years of prior experience with the following abilities:

1. Organize, prioritize, and manage multiple tasks with a high level of detail.

2. Strong Analytical Skills (Manipulation of data/ Testing and Configuration.)

3. Ability to work in a high production, time sensitive environment.

4. Computer Knowledge including but not limited to Microsoft office products, Windows based operations.
Preferred Qualifications

1. Previous Prior Authorization Experience and Knowledge.

2. Self-motivated individual with a quick learning curve on complex materials.

3. Excellent Oral and Written communication skills to be utilized in a consultative fashion.

Education
Required - High School or Equivalent

Preferred - Bachelor's Degree

Work Environment

Work from Home

Pay Range

The typical pay range for this role is:

$43,888.00 - $85,068.00

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 Benefits | CVS Health

We anticipate the application window for this opening will close on: 12/13/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.