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CVS Health Pharmacy Technician Supervisor - Medicaid - FULL WORK FROM HOME in Texas

Job Description

The Supervisor Medicaid Operations will be responsible for providing operational leadership and direction for the Medicaid Prior Authorization and Appeals business units. This position has a primary focus on ensuring compliance with all state Medicaid regulations. Other key areas of focus include quality improvement, innovation and reduction of unit costs. Responsibilities of the position include daily operational oversight, staff development, budget management, audit readiness, staff training documentation and execution and policy and procedure documentation. The leader will work with internal partners and the Medicaid staff to ensure ability to service physicians, pharmacists and patients within service levels and provide for appropriate clinical drug therapies. Essential functions of the job include: lead the PA & Appeals operational unit for Medicaid including ensuring regulatory compliance with state regulations regarding the processing of prior authorizations and appeals; ensure standardization and consistency in practices, procedures and workflow to improve efficiency and quality; coordinate with IROs and IRE external organization to ensure business requirement are met; develop an annual business plan for the department to include revenue and expense forecasts, resource justifications and performance analysis of the department; understand and ensure end to end regulatory compliance with all state, federal and other regulatory and client requirements; work with Compliance, Legal, Account Management, IT, Clinical Development and various internal departments to coordinate operational initiatives that achieve compliance; work with peers and staff to ensure understanding and execution of operational and business requirements; ensure staff is help accountable to quality, training and production metrics; ensure processes are documented and trained; run day to day operations for Medicaid PA and Appeals; represent the Medicaid Ops process through client facings, client work group meetings and work with clients when needed regarding implementation and on going maintenance of their business.

Required Qualifications

  • At least two years of relevant work experience required (including prior experience in a leadership position)- Clinical Services Operations or Management experience- Prior Authorization and/or Appeals experience; or PBM/Pharmacy Operations or Management experience.- Pharmacy Technician Registration

Preferred Qualifications

PTCB Certified Experience and success in fast pace, multi-tasking team environment while meeting deadlines Highly skilled in leading significant change efforts and in building strong partnerships with business-line executives Ability to summarize complex issues and problems into a concise report, focused on key findings and outcomes Proficiency in developing communication strategies for a wide array of audiences that support strategic objectives Demonstrated sophisticated written and verbal presentation abilities Substantial experience with the development of presentation materials (collateral, proposals, presentations, talking points, etc.) Proficiency in the management of time, flexibility, and influencing colleagues to meet demanding project timelines Developed ability to use various PC software programs: Microsoft Word, Excel, Access, and PowerPoint UM or PA system knowledge desired Previous project management desired Strong verbal and written communication skills and ability to form cross functional partnerships to accomplish goals. Strong coaching and interpersonal skills Ability to cultivate a strong internal culture designed around collaboration, feedback, motivation and accountability Strong leadership and collaboration skills that drive results


Bachelor’s Degree: Or combination of education and relevant work experience.

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.