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Manager, Clinical Adjudication – Prior Authorization Solutions
Location
Arizona + 3 moreAll locations: Arizona | Illinois | Rhode Island | Texas
Posted
115 days ago
Salary
$60.3K - $145.9K / year
Seniority
Senior
Job Description
Manager, Clinical Adjudication – Prior Authorization Solutions
CVS Health
• Lead and close deliverables related to department initiatives and PA activities in a timely manner • Support CAPAS service catalog offerings • Maintain CAPAS service-related job aids and documentation • Drive innovative improvements across CAPAS operations • Validate functionality of new programs and innovations • Support implementation of client PA files during the clinical review portion of member data transitions • Assist partners in understanding adjudication claim processing • Provide training and cross-training to internal CAPAS team members, including new hires and advanced deep-dive sessions
Job Requirements
- Minimum 5 years of experience with RxClaim, specifically in adjudication related to Prior Authorization overrides
- Experience running queries in RxClaim and/or Data Warehouses
- Advanced proficiency in Microsoft Office Suite, particularly Excel, Access, and Visio
- Knowledge of CVS Caremark clinical programs (e.g., Benefit plan setup, formularies, utilization management) (Preferred)
- Experience developing or enhancing training materials (Preferred)
- Familiarity with Microsoft Power Platform (Preferred)
- Bachelor’s degree required; equivalent work experience may substitute
Benefits
- Affordable medical plan options
- 401(k) plan (including matching company contributions)
- Employee stock purchase plan
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Paid time off
- Flexible work schedules
- Family leave
- Dependent care resources
- Colleague assistance programs
- Tuition assistance
- Retiree medical access
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