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

Company Overview

CVS Health is a leading health solutions company that delivers cutting edge care solutions to patients and clients. We help patients/members prevent and navigate chronic conditions through analytically driven personalized care management and delivery. We help improve access, lower costs, impact root causes of disease progression, and deliver a trusted experience to meet our members where they are. As one of the most trusted brands in the nation, our deep relationships with more than 100 million members give us a distinct advantage. Centering our work around consumers at an unequaled scale enables us to drive deeper penetration of our health products and services and meet their everyday health needs. We are dramatically reshaping how they experience care, with a unique blend of consumer, health care, and risk management expertise all within one company.

The CVS Health Care Management Solutions organization designs, delivers, and operates configurable collection of products, initiatives, and tools that complement the benefit plans of our enterprise employer and health plan customers. Our solutions target population health outcomes that require risk mitigation, intervention, and ongoing chronic care management.  We use technology-enabled population identification based on multisource data integration – medical claims, pharmacy claims, lab data and member feedback – for applying evidence-based opportunities and an omnichannel, next best action approach. Advanced analytics drive higher engagement and better care delivery through a comprehensive machine learning platform and our one-on-one connections.

Position Summary

We are seeking a Member Experience & Support Manager for our Weight Management product within our Care Management Solutions team.

As a Member Experience & Support Manager for Weight Management, you will play a critical role in product delivery and support.  You will work directly with the product’s member-facing teams and stakeholders, including clinicians, our member care support teams and client account teams to intake, document, and coordinate resolution of member questions or issues that may arise from the Weight Management program.  You will support a positive member experience by ensuring escalations are investigated and resolved in a timely manner, and that resolution is communicated back to members and all appropriate stakeholders.  You will also look for opportunities to improve overall member experience through key learnings from escalated questions or issues.

Some of your key responsibilities will include:

• Maintain an organized database of all escalations from member-facing teams to enable timely resolution and documentation of member escalations
• Monitor for and intake new escalations each day, investigate with appropriate teams and tools, including our Rxclaims systems (COS) and Weight Management program database
• Oversee escalation resolution and follow up to members via member-facing teams; coordinate and communicate resolution with / to appropriate teams including Product, clinical teams, and account teams
• Develop and execute training and enablement of member-facing teams to help proactively address common member escalations or questions
• Regularly engage Product for any changes or additions to product requirements that may impact members
• Support and lead initiatives to improve and scale member escalations processes
• Mentor, coach, and influence others to maintain positive business relationships and grow their potential

Capabilities:

The ideal candidate is a strategic and tactical problem solver with a “hands-on” orientation, who understands what it takes to drive real operating change, can create a sense of urgency, make decisions quickly, and effectively influence others.  They should be able to demonstrate:

• A deep enjoyment for getting into the details of how the products work and how to quality-check to ensure a positive member experience
• Experience with care management product management and Rx claims
• Strong organizational skills, structured and logical thinking, and highly developed project management skills
• Familiarity with interpreting member journeys
• Powerful communication with the ability to succinctly convey complex requirements to a diverse range of constituents, both technical/development teams and business stakeholders
• Fluency with common analytics and communications software – primarily Excel and PowerPoint (Tableau experience is a plus)
• Relationship-building skills and the ability to foster effective working relations across a cross-functional team including functional and divisional leaders
• A results-focused, self-starter mentality
• Ability to develop clear goals and plans and deliver against them
• Proactive thinking and delivering more than has been agreed
• Ability to work across multiple projects and products at one time
• Intellectual curiosity and tenacity
• Enjoyment working at pace and in a dynamic environment.

Required Qualifications

• 2 years of experience in healthcare or Rx payer operations, member support, or care management  

• Experience effectively working with multiple functional areas such as Product, clinical teams, account teams, member support, regulatory

Preferred Qualifications

• Previous experience working with remote teams

• Excellent design intuition/background

Education

Bachelor's degree or equivalent practical experience.

Location

This position can work remotely or office from one of the CVS Health corporate locations in Boston, New York, Chicago, or Scottsdale. Occasional travel is required and will be more frequent for locations outside of Boston.

Pay Range

The typical pay range for this role is:

$60,300.00 - $132,600.00

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: 11/22/2024

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