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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 Supervisor is responsible for oversight of healthcare management staff including the organization and development of high performing teams.-Works closely with Co-workers, leadership, provider services, and other ancillary departments to ensure consistency in management of post service review of provider and member claims related to code edits and medical necessity review.

-Manages a team of staff responsible for the review of post-service provider and member claims.

-Serve as a content model expert and mentor to the team regarding practice standards, quality of interventions, and problem resolution.

-Ensure implementation and monitoring of best practice approaches and innovations to better address the member's and provider needs.

-May act as a liaison with other key business areas.

-May develop/assist in development and/review new training content

-Protects the confidentiality of member information and adheres to company policies regarding confidentiality

-Manages non-clinical staff that are responsible for post service claim review that includes evaluation of system information,

-Requires collaboration and meetings with teams outside of CCR including customer and provider services, account teams, legal and compliance, medical policy, and others as required to meets our customer needs and to resolve issues through projects.

-Participate in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical and performance skills.

-Consistently demonstrates the ability to serve as an model change agent and lead change efforts

-Create a positive work environment by acknowledging team contributions, soliciting input, and offering personal assistance when needed.

-Accountable for maintaining compliance with policies and procedures and implements them at the employee level.

Required Qualifications:

3+ years managed care experience that includes experience in Utilization Management and claims processing workflows

Preferred Qualifications:

-Computer literacy and experience with Microsoft products

2+ years claims processing experience

Customer Service Experience

Proficiency in multiple systems including EWMP, CEC, ATV, MedCompass, HRP, and TPS.

Education:

High School Diploma or GED

Anticipated Weekly Hours

40

Time Type

Full time

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: 03/02/2025

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

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.