Description

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

As an Audit and Testing Program manager, you will provide technical, analytical, and business support for all assigned programs for Medicare, Medicaid, and Commercial products. Programs currently include End-Stage Renal Disease (ESRD), Hospice, Transplant, Transition Fill and Part D Vaccine Administration. You will support CMS program audits by delivering pertinent information in advance of audits and adequately communicate implications to ensure a successful audit experience for our clients. Your ability to research claims, read benefit setups in RxClaim, and articulate risks or concerns is critical. You will also manage deliverables resulting from audit activities. These deliverables might include corrective action plans, issue narratives, and talking papers for system logic. You will also be required to speak to Med D compliance and reporting documentation associated with our clinical programs. You will be expected to develop IT query writing and data analysis, business impact analysis; and root cause analysis. You will be asked to present claims in RxClaim via live webinars with CMS and clients.

The second component of this role involves year-round quality assurance testing. As new programs, processes, and technology are deployed, you will need to incorporate these into all aspects of the testing program, demonstrate validation of functionality for internal and external partners, and initiate corrective actions to resolve any issues. Your efforts around testing will ensure a smooth and successful go-live for new clients, and that CVS is able to provide all members with the appropriate and necessary access to the care they need.

Required Qualifications

Knowledge of:

• 3+ years of Pharmacy Benefit Management, Medicare Part D or Medicaid experience
• 2 + years of in-depth knowledge of pharmacy products, services, and system capabilities

Preferred Qualifications

Knowledge of:

• Collaboration tools such as Microsoft Teams, OneNote, SharePoint 365, etc.
• Reporting programs such as RxNavigator to review and develop reports
• Microsoft Project software to create and maintain project plans

Skill in:

• 1+ years of project management or business analyst experience including the management of complex requirements

• 1+ Experience with the RxClaim software system
• Developing and maintaining effective work relationships

• Strong analytical skills and problem-solving abilities
• Negotiation and conflict resolutions skills across various levels of an organization
• Strong interpersonal communication skills using active listening and open-ended questions to encourage others' points of view to influence
• Effective verbal and written communication skills

Ability To:

• Interact with various levels of an organization, including senior leadership

• Prepare and deliver presentations to clients
• Analyze large data files to find root cause
• Have regular and predictable attendance
• Travel for business support less than 20% of the year
• Be vaccinated for COVID-19

• Attention to detail and accuracy
• Highly organized and able to quickly prioritize multiple assignments
• Exercise creativity and innovation in achieving project results

Education
Bachelor's degree of equivalent experience.

Anticipated Weekly Hours
40

Time Type
Full time

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.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 09/30/2025

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