Job Description
A Senior Manager who can formulate and execute a strategic vision to catapult four Encounter Operations Teams to the next level of success. The ideal candidate will access the operational processes across not only the day to day operations but all areas that feed into the Encounter Program, in order to suggest and implement changes that will improve encounter procedures and client satisfaction. This Sr. Manager will need to be forward thinking in order to anticipate and comprehend Medicaid State Agency trends and quickly change strategy based on regulatory changes. The ideal candidate will need to be comfortable operating in a highly regulatory environment that is constantly changing, and is attached to highly visible performance guarantees. We need a person who can hit the ground running, which requires a candidate that has SME level knowledge of the Medicaid Encounter process; from creating an Encounter File to sending corrections out the door.

The Sr. Manager will manage four teams who are responsible for researching, analyzing, summarizing and categorizing Medicaid Encounter rejects from various states. People who enjoy working with large amounts of data and be able to find creative solutions to issues. The members of the team are self-starters who also has great communication skills to work directly with clients on a weekly basis to resolve issues. High attention to detail is also a very important component to this position.

Required Qualifications
5 or more years of PBM Experience
3 or more years of Encounter Experience
2 or more years of Management Experience

COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.

• If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.

• If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications
• Healthcare Operations in addition to PBM
• Eligibility Data
• Project Management
• Maneuvering a dynamic, matrixed organization
• Troubleshoot claim adjudication issues

Education
Bachelors degree required

Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. 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.