Sr. Manager, Regulatory Resolution Team at CVS Health

Hartford, Connecticut, United States

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

7+ years of experience in health care industry or regulatory environment
5+ years of experience in claim and payment policies and administration, operational, and clinical policies
Bachelor's degree required or equivalent years of related experience
Strong skills in interpreting state and federal requirements
Ability to prioritize work in a fast-paced environment
Expert technical and written communication skills
Excellent problem solving and decision-making skills, including taking initiative to resolve complex issues and discern relevant information

Responsibilities

Manage and lead a group of colleagues responsible for pulling together responses to member and provider regulatory complaints
Oversee the scheduling, drafting, timeliness and quality of regulatory responses
Proactively monitor team case load, status of response letters and associated due dates
Interface and negotiate with state and federal regulators, as needed
Build, maintain and promote positive and effective working relationships with internal and external stakeholders
Identify opportunities to streamline processes and improve efficiencies within the RRT and key business partners. Encourage staff to embrace new processes and identify change management opportunities within the team
Hold team accountable for meeting goals, due dates and expectations, identifying areas of individual performance concerns and coaching opportunities

Skills

Key technologies and capabilities for this role

Regulatory ComplianceRisk AnalysisStakeholder ManagementTeam LeadershipProcess ImprovementChange ManagementNegotiationCase ManagementPerformance ManagementAdvocacy

Questions & Answers

Common questions about this position

What qualifications are required for the Sr. Manager, Regulatory Resolution Team role?

Candidates need 7+ years of experience in the health care industry or regulatory environment, and 5+ years of experience in claim and payment policies and administration, operational, and clinical policies. A Bachelor's degree or equivalent years of experience is also required.

What key skills are needed to succeed in this role?

Success requires strong skills in interpreting state and federal requirements, ability to prioritize in a fast-paced environment, expert technical and written communication skills, and excellent problem-solving and decision-making skills.

Is staff management experience required for this position?

Staff management experience is listed as a preferred qualification, not a requirement.

What is the salary or compensation for this role?

This information is not specified in the job description.

Is this a remote position or does it require office work?

This information is not specified in the job description.

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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