Pharmacy Claim Quality Review and Audit Manager-Express Scripts (Remote)

Summary

Manager of Desk Audit (Pharmacy Audit) owns the output of a single work area within Quality Review and Audit and typically manages a team of Quality Assurance/Audit job family roles. Responsible for developing and leading Total Quality Management strategies for work team which may include improvement of processes, coaching support and audit measurement. Leads efforts to identify operational improvement opportunities that have a direct impact on the customer, provider, or vendor partner. May provide oversight for issue evaluation and resolution and may be involved in developing and recommending changes in processing procedures. May provide oversight for complex operational audits or regulatory inquiries. Utilizes in-depth professional knowledge of pharmacy billing practices but is guided by functional practices and well-defined management precedents. Focuses on implementing and executing strategies within own department/discipline/team.

Responsibilities include:

The Desk Audit manager is responsible for using analytical skills and audit tools to identify network pharmacy audit risks and develop/execute audit plans and scope of procedures determined necessary to address those risks.

• Develop and produce reports as required to meet needs of department, Account Managers, pharmacies and chain audit contacts, clients and other stakeholders. Providing updates to management on current status of audits including any escalated issues.
• Prepare for and participate in client communications, including conference calls to present status updates of ongoing issues, results of completed audits, etc., for assigned clients.
• Coach and develop team, oversee resolution of employee relations issues, oversee hiring and training of new associates, and manage workload assignments all aimed at ensuring the team succeeds in achieving a high-level of client satisfaction, as well as their own professional achievements

Requirements include:

• BA/BS degree preferred, HS Diploma Required
• Certified Pharmacy Technician (CPhT) preferred
• At least 3 years of relevant pharmacy experience in either retail or PBM setting pharmacy and audit experience in healthcare setting.
• Leadership /Supervisory experience
• Ability to succeed in a dynamic, high-pressure environment and develop a culture of ownership and personal accountability
• Ability to motivate employees, handle difficult employee relations issues and create a culture that supports high employee morale
• Strong Proficiency in MS office applications
• Excellent organizational, interpersonal, communication and leadership skills

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an annual salary of 86,900 - 144,900 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group.

About Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

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