Supervisor - Medicaid Operations - WORK FROM HOME

Job DescriptionThe Supervisor Medicaid Operations will be responsible for providing operational leadership and direction for the Medicaid Prior Authorization and Appeals business units. This position has a primary focus on ensuring compliance with all state Medicaid regulations. Other key areas of focus include quality improvement, innovation and reduction of unit costs. Responsibilities of the position include daily operational oversight, staff development, budget management, audit readiness, staff training documentation and execution and policy and procedure documentation. The leader will work with internal partners and the Medicaid staff to ensure ability to service physicians, pharmacists and patients within service levels and provide for appropriate clinical drug therapies. Essential functions of the job include: lead the PA & Appeals operational unit for Medicaid including ensuring regulatory compliance with state regulations regarding the processing of prior authorizations and appeals; ensure standardization and consistency in practices, procedures and workflow to improve efficiency and quality; coordinate with IROs and IRE external organization to ensure business requirement are met; develop an annual business plan for the department to include revenue and expense forecasts, resource justifications and performance analysis of the department; understand and ensure end to end regulatory compliance with all state, federal and other regulatory and client requirements; work with Compliance, Legal, Account Management, IT, Clinical Development and various internal departments to coordinate operational initiatives that achieve compliance; work with peers and staff to ensure understanding and execution of operational and business requirements; ensure staff is help accountable to quality, training and production metrics; ensure processes are documented and trained; run day to day operations for Medicaid PA and Appeals; represent the Medicaid Ops process through client facings, client work group meetings and work with clients when needed regarding implementation and on going maintenance of their business.Pay RangeThe typical pay range for this role is:Minimum: 40,600Maximum: 81,100Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required Qualifications- At least two years of relevant work experience required (including prior experience in a leadership position)- Clinical Services Operations or Management experience- Prior Authorization and/or Appeals experience; or PBM/Pharmacy Operations or Management experience.- Pharmacy Technician RegistrationCOVID 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 QualificationsExperience and success in fast pace, multi-tasking team environment while meeting deadlines Highly skilled in leading significant change efforts and in building strong partnerships with business-line executives Ability to summarize complex issues and problems into a concise report, focused on key findings and outcomes Proficiency in developing communication strategies for a wide array of audiences that support strategic objectives Demonstrated sophisticated written and verbal presentation abilities Substantial experience with the development of presentation materials (collateral, proposals, presentations, talking points, etc.) Proficiency in the management of time, flexibility, and influencing colleagues to meet demanding project timelines Developed ability to use various PC software programs: Microsoft Word, Excel, Access, and PowerPoint UM or PA system knowledge desired Previous project management desired Strong verbal and written communication skills and ability to form cross functional partnerships to accomplish goals. Strong coaching and interpersonal skills Ability to cultivate a strong internal culture designed around collaboration, feedback, motivation and accountability Strong leadership and collaboration skills that drive resultsEducationBachelor's Degree: Or combination of education and relevant work experience.Business 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