Advisor, Program Manager, Medicare Part D

Job DescriptionAs an Advisor, Program Manager, Medicare Part D, you will provide technical, analytical, and business support for all assigned programs for Medicare, Medicaid, and Commercial products. Programs currently include End-Stage Renal Disease (ESRD), Hospice, Transplant, Transition Fill and Part D Vaccine Administration. You will be asked to develop business requirements used by clients to develop their own policies and procedures. You will work with benefit relationship managers, account teams, financial advisors to answer questions and support clients and their members who are affected by our programs. You will serve as a subject matter expert in programs assigned and be able to explain and present program functionality from a system logic perspective as well as a business program management. You will accomplish this by: Providing detailed and technical functional design requirements to internal and external business partners. Producing and maintaining business process documentation, such as policies and procedures, job aides and work instructions. Analyzing daily program reporting and RxClaim adjudication data to ensure program oversight Identifying and reporting instances affecting performance guarantees and service level agreements Providing root cause analysis through claim adjudication research and data trends Supporting internal and external audits and ensuring audit responses are timely and accurateYour success will be driven by your ability to provide strategic guidance to internal and external business partners, exhibiting a high level of accountability. Your contributions will ensure program compliance with all client & regulatory requirements. Your success will be measured through client satisfaction, timely completion of tasks and deliverables, and effective, accurate documentation.To be a candidate for this role you will possess the following: In depth knowledge of pharmacy products, services, and system capabilities Experience interacting with various levels of an organization, including senior leadership Experience preparing and delivering presentations to clients Ability to analyze large data files to find root cause Have regular and predictable attendance Ability to travel for business support less than 20% of the year Ability to develop and maintain effective work relationshipsThis is a work from home role. Candidates can live anywhere in the USRequired Qualifications At least 5 years of work experience 3+ years of Pharmacy Benefit Management, Medicare Part D or Medicaid experience 1+ years of project management or business analyst experience including the management of complex requirements 1+ years of experience with the RxClaim software system In depth knowledge of pharmacy products, services, and system capabilitiesCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues 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, religious belief, or other legally recognized reasons that prevents them from being 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 or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications Reporting programs such as RxNavigator to review and develop reports Microsoft Project software to create and maintain project plans Strong analytical skills and problem-solving abilities Attention to detail and accuracy Negotiation and conflict resolutions skills across various levels of an organization Highly organized and able to quickly prioritize multiple assignments Strong interpersonal communication skills using active listening and open-ended questions to encourage others' points of view to influence Effective verbal and written communication skills Exercise creativity and innovation in achieving project resultsEducation Bachelor's degree is required; equivalent work experience may substituteBusiness OverviewBring your heart to CVS HealthEvery 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.

Created: 2025-11-15