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CVS Health logo
CVS Health

Bringing our heart to every moment of your health.

Manager, Clinical Adjudication – Prior Authorization Solutions

ManagerManagerOtherRemoteSeniorTeam 10,001+Since 1963H1B No SponsorCompany SiteLinkedIn

Location

Arizona + 3 moreAll locations: Arizona | Illinois | Rhode Island | Texas

Posted

115 days ago

Salary

$60.3K - $145.9K / year

Seniority

Senior

Bachelor Degree5 yrs expExperience acceptedEnglish

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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