Pharmacy Management Analyst - Full-time / Part-time

Job Category: Analytics, Program Management

Clinical Licensure Required : N/A

Job Type: Full Time Position Summary:

This position is primarily responsible for supporting operations and development within CVS/specialty's medical claims engine (Novologix). The Analyst will be responsible for the maintenance and implementation of the claim engine's various service offerings and the support of current clients. In addition, the analyst will support the drug claim review process including manual drug review, reporting, interaction with payers and providers, drug claim holds and rejects, and automated drug review rules development and maintenance. The position also has cross-functional responsibility to support and/or participate in the activities of other departments within CVS Health.

Responsibilities

1. Supports business operations and client implementations in the development and maintenance of prior authorization critera, fee schedules, client set-ups, and clinical edits within the Novologix system - 40%

2. Supports client implementations through development and implementation of client specific operational requirements - 15%

3. Develops knowledge of drug database and assists with questions and processes related to drug database, NDC/HCPCS crosswalk and drug pricing calculations and loads - 15%

4. Performs daily drug claim review and assists in resolving related issues, performing related reports, and conducting routine claim rejection process. Accesses internal and external databases and sources (providers) to obtain needed information - 15%

5. Monitors the Pharmacy and Drug Review incidents and facilitates the resolution of incidents related to drug and miscellaneous code claim review - 15%

Required Qualifications:

* 1-2 years experience in a working environment that requires knowledge of Pharmaceuticals, Infusion Products, and Medical Terminology.

* Written and verbal communication skills to initiate professional and effective contact with internal and external customers.

* 1-2 years of demonstrated ability to work independently and manage multiple projects. Strong time management skills.

*Ability to communicate effectively with internal and external stakeholders.

*Ability to make timely and sound decisions based on adequate information.

*Ability to identify and use appropriate resources and knowledge to solve problems and resolve issues.

*Ability to identify, document, and implement effective processes and procedures for accomplishing work.

*Moderate to Advanced user of Microsoft Office Suite (Word, Excel, and Outlook)

Preferred Qualifications:

* Knowledge of HCPCS Level I and II coding.

* Experience working within an IT environment

* Skill in analyzing data and reports and generating recommendations for process change.

Education:

*Bachelors Degree and 2+ years experience in Pharmacy, Home Health Care, Home Infusion or Pharmacy Benefit Management; or a combination of education and experience providing equivalent knowledge.

*Pharmacy Technician Certification or at least 2 years of equivalent experience.

Business Overview:

CVS Health, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation's largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units -- MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.