Bring your heart to CVS Health. Every 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.Brief Overview
As a Manager, Investigations - FEP MQA for CVS Health, you will Manage and optimize operational processes within healthcare organizations by developing and implementing strategic initiatives, analyzing data to drive process improvements, collaborating with cross-functional teams, and providing guidance and mentorship to junior staff. You will Enhance operational efficiency, ensure compliance with regulatory standards, and contribute to the overall success of healthcare operations.
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What you will do
- Oversee and manage investigations related to fraud, waste, and abuse within the Federal Employee Program (FEP) Member Quality Assurance (MQA) department.
- Lead efforts to detect and investigate instances of fraud and abuse within the FEP MQ program.
- Develop and implement proactive measures, such as data analytics, claims reviews, and other investigative techniques, to identify suspicious patterns or practices that may indicate fraudulent activities.
- Assist in the development of investigation plans and strategies to effectively address potential fraud or abuse cases.
- Collaborate with various internal departments, such as legal, compliance, claims, and provider relations, to ensure a coordinated approach to FEP MQA investigations.
- Ensure quality documentation of investigation activities, including evidence collection, witness statements, case files, and other relevant information to facilitate transparency.
- Coach an investigation team through the documentation of investigation activities, including evidence collection, witness statements, case files, and other relevant information.
- Manage team performance through regular, timely feedback as well as the formal performance review process to ensure delivery of exceptional services and engagement, motivation, and team development.
- Contribute to the development and enhancement of policies, procedures, and protocols related to FEP MQA investigations.
- Adept at problem solving and decision making skills.
- Adept at collaboration and teamwork.
- Adept at growth mindset (agility and developing yourself and others) skills.
- Adept at execution and delivery (planning, delivering, and supporting) skills.
- 5 or more years of work experience.
- Investigative work experience.
- Experience managing multiple cases loads.
- Experience training peers and presenting to leadership.
- Experience/ Proficy with the Microsoft office suite.
- Healthcare experience.
- Pharmacy Benefit Manager (PBM) experience.
- Bachelor's degree required, may consider equivalent experience in lieu of a Bachelor's degree.
The typical pay range for this role is:$54,300.00 - $119,340.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit Benefits | CVS HealthWe anticipate the application window for this opening will close on: 01/19/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.