Lead Director, Pharmacy Appeals

Job not on LinkedIn

November 25

🌵 Arizona – Remote

Although this job is listed in Arizona, this company may be open to hiring remote in other states.

💵 $100k - $231.5k / year

⏰ Full Time

🟠 Senior

👔 Director

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CVS Health

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Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

📋 Description

• Lead a team of 40+ colleagues in the management of pharmacy reimbursement appeals • Ensure the appeals are executed under tight Turnaround Times (TATs) and with high accuracy • Develop and implement solutions to improve and automate processes • Guide internal business units to resolve issues quickly • Responsible for working with the Presidential Response Unit (PRU) to resolve pharmacy appeals • Ensure compliance with legal and regulatory updates • Oversee quality control processes

🎯 Requirements

• 10 year’s experience in healthcare industry with experience in price management, optimization or modeling. • 5+ years directly leading operations teams • 1+ years’ experience with pharmacy appeal related processes and state regulations, and claims adjudication • Outstanding written and oral communication skills • Requires exceptional judgment, discretion and confidentiality • Excellent leadership skills • Proficient in Excel, MS Access, Salesforce, and Pharmacy Portal • Strong mathematical problem-solving skills • Prior PBM Knowledge • Familiarity with wholesaler invoices

🏖️ 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