The Clinical Services- PA Admin Consultant will be a Prior Authorization system Subject Matter Expert providing support for the Prior Authorization/Appeals Operational and Client Support teams. This position works closely with and fosters communications with internal and external departments including IT Teams, Clinical Development, Liaisons, Account Teams and Prior Authorization Operations to ensure effective execution of programs being processed and implemented. The Clinical Services Consultant will participate in projects and activities related to the Prior Authorization system including configuration and process improvements; assistance in executing user acceptance testing for system enhancements; Managing internal workflows for specific lines of business including case management; Utilizing feedback from user groups to work with Business Intelligence, IT and the business to aid in the development and deployment of system enhancements; Documenting ideas for process improvement; Facilitating meetings; Ensuring projects and system enhancements meet both state and federal requirements; Departmental training.
Pay Range
The typical pay range for this role is:
Minimum: 18.50
Maximum: 34.60
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.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit
Required Qualifications
Preferred Qualifications
Education
High School Diploma or GED Equivalent
Business Overview
Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected 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.
$ads={1}
In addition, work with a team of system trainers to provide consistent back-end user support, assist in documentation and maintenance of user guides presentations and corrective action plans, provide system demos and help mentor and support as a subject matter expert for their team.- Build client setup within the PA system, as well as testing/quality checking to ensure client buildouts meet client and operational needs in order to assure teams are within compliance. Coordinating the PA System implementations by meeting with internal and external partners to gather and document client requirements, state regulations, and Caremark Prior Authorization department needs. 40%
- Creates, maintains, and communicates PA System and process documentation. 20%
- Provides ongoing continued support for internal and external partners such as facilitating meetings, projects and process implementations. Acting as liaison between PA Operations, PA Admin, Client users, and account management. Builds and sustains working relationships with Operation leaders, PA Admin leaders, IT contacts, client contacts, and account team members to fully support our clients’ needs.
- 20%
- Working closely with IT, by submitting BSR requests based on client, operations, and regulatory requirements. Participating in PA System Release User Acceptance Testing and coordinating Beta testing. 10%
- Assist other colleagues in the various aspects required to function effectively in their roles. Facilitate Prior Authorization System demos to internal and external system users and partners 10%
Pay Range
The typical pay range for this role is:
Minimum: 18.50
Maximum: 34.60
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.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit
jobs.CVSHealth.com/benefits
Required Qualifications
- Proficiency with Excel, Word, and PowerPoint.
- Strong PA Systems knowledge.
- Exceptional communication skills (oral and written).
- Knowledge of Prior Auth and Appeals activities
- Current or previous PA system setup experience
- Self-directed with proven ability to manage and prioritize multiple projects simultaneously and meet deadlines.
- Create and update training materials and documentation
- Conduct remote training classes and presentations
- Organize and prioritize work streams for a specific line of business
- Quality Assurance experience, oversee quality efforts on work performed by others
- Subject Matter Expert to assist teammates with difficulties encountered in their daily work activities
- Data Entry experience
- Project assistance experience
Preferred Qualifications
- Motivated, presentation skills, and flexibility.
- Ability to meet strict deadlines.
- Proven capability to work with people at all levels of an organizations.
- Ability to work across boundaries to achieve goals.
- Energetic and highly motivated to provide exceptional client support and service
- Support leadership in issue resolution
- Track and correlate information for reporting
- Troubleshoot reported problems
Education
High School Diploma or GED Equivalent
Business Overview
Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected 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.
$ads={2}
