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Job Title :
Quality Advisor - Process Improvement
Job ID :
Location :
AZ - Scottsdale
Street Address :
9501 E Shea Blvd
Category :
Business Analyst|Process Innovation|Project Management
Description :
Job Description
The Quality Advisor fulfills the company purpose of helping people on their path to better health by driving quality execution of PBM functional area performance. Under the supervision of the Director of Member Services Quality, the Quality Advisor will analyze and transform quality data into meaningful reports and summaries that help to identify process gaps and other improvement opportunities and provide recommendations for change. By interacting and consulting with business partners, the Advisor in this role will bring expertise to Quality Assurance assessment activities with emphasis utilization management, patient safety, clinical programs, prescription accuracy and quality measures.

The Quality department is responsible for monitoring the performance of individual business operations within the PBM that support all market segments (Commercial, Specialty Pharmacy, Medicare D, and the Health Insurance Marketplace). Member Services Quality evaluates functional area performance using various techniques, standards and methodologies to validate compliance with regulations and internal processes and procedures. The role of Quality in the organization is to detect, assess and reduce operational risk.

Responsibilities include:

- Analysis of quality data and sharing observations and recommendations to improve identified gaps with business partners.
- Assist with Quality Assurance strategy implementation in response to updates and changes in business or regulatory requirements and accreditation standards.
- Consulting with PBM business operations to assess their existing quality control processes and make recommendations for change where needed.
- Validating effectiveness of improvements made by the operation and establishing routine assessment of these operations to verify that changes continue to be sustainable and appropriate in response to the changing regulatory environment.
- Planning and execution of QA initiatives; establishing tasks, deliverables and time lines in coordination with the Manager and Director of Quality Assurance. Managing project plans. Will need to have an understanding of dependencies and ability to coordinate resources as needed to achieve the goal.
- Reviewing and interpreting PBM standards outlined by regulatory and accreditation agencies
- Identifying quality best practices and developing standard quality protocols that can be widely deployed across the PBM.

Required Qualifications
- 5+ years’ experience in fast paced highly regulatory environment or data driven role
- 2+ years experience managing project plans of execution including tasks, time lines and milestones.
- 2+ years presentation experience which includes creating and delivering successful PowerPoint presentations without significant input and direction.
- 2+ years working in the healthcare industry.
- Has demonstrated a diplomatic approach to working with business partners while applying the “trust but verify” approach
- Innovative, self-starter; solves for the objective creatively, does not require that a step-by-step plan be defined for them
- Proven ability for analyzing large volumes of data, highlighting risk based upon trend analysis
- Reporting, statistics, trends as well as understanding and diagnosing root causes, creating and developing reports or directing the development of said reports to obtain required informatics. Capable of transforming data into meaningful and accurate conclusions.
- Prior role in audit, compliance, data analytics and reporting and/or process improvement and experience in Pharmacy Benefits Management or related field (especially Medicare Part D, Medicaid, Mail Order and and/or Commercial and Exchanges preferred)
- Ability to travel 15%
- Ability to write technical requirements documents for all new IT processes and act as a liaison with the QA MACRO team
- Proficiency in Excel, Access, Word and Powerpoint
- Strong data anaylsis skills required

Preferred Qualifications
Medicare D experience or Health Plan experience
Experience with Tableau reporting system
Understanding of basic Six Sigma process

Bachelor Degree or equivalent work experience

Business Overview
CVS Health, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units – MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.

CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law. CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance to apply for this job, please contact us by clicking EEO AA CVS Health

CVS Health does not require nor expect that applicants disclose their compensation history during the application, interview, and hiring process.

For inquiries related to the application process or technical issues please contact the Kenexa Helpdesk at 1-855-338-5609. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352. Please note that we only accept resumes via our corporate website:

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CVS Health core values of Innovation, Collaboration, Caring, Integrity, and Accountability not only support our purpose of helping people on their path to better health for our customers and patients, but they also apply to how we support our more than 250,000 colleagues. You will find our culture at CVS Health, and our leaders encourage personal and professional growth.

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