Senior Manager, Compliance Business Manager-Network Management at CVS Health

Hartford, Connecticut, United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

5+ years compliance and/or audit experience in SOC and SOX controls
5+ years of project management experience
Health insurance industry experience
Strong communication, critical thinking, problem resolution and interpersonal skills with proven ability to influence and collaborate with providers and internal partners at all levels
Leadership qualities, strong communication skills, and strategic thinking
Able to drive decisions based on data analysis
Bachelor's degree preferred / specialized training / relevant professional qualifications
Advanced working knowledge of business systems, applications, and tools supporting network management, contracting, and provider data systems (preferred)
Experience in related business environment with exposure to provider data, processes, etc. (preferred)

Responsibilities

Understanding the business to identify when a new control is required
Facilitation of business process and control documentation, including writing new controls and ensuring controls are designed appropriately to manage risk
Identify and proactively notify all impacted areas of control changes that may require enhancements, process changes or other updates
Partner with stakeholders to continuously evaluate and recommend opportunities to reduce risk, strengthen the control environment, and introduce operational efficiencies
Accountable for all steps within the life cycle of control testing including conducting walkthroughs with Internal and External auditors, maintaining Information Provided by Entity (IPE) and providing documentation as needed when audit selections are made
Responsible for monthly and bi-annual control review, including audits of Provider Tab and Rate Wizard transactions, Fee Schedule and Rate Load Tracking Database audits
Support audits out of QNXT and PRMS to support Medicaid SOC and SOX controls
Coordinate with applicable reporting areas as needed to ensure reports are generated timely and are continuously reviewed for process efficiencies
May be asked to support other projects as needed based on business need

Skills

SOX

SOC

Compliance

Risk Management

Control Design

Audit Walkthroughs

Control Testing

Business Process Documentation

Provider Network

Medicaid

Fee Schedule Audits

QNXT

PRMS

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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