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Senior Representative, Clinical Support at CVS Health in Remote
Skills
Job Description
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary
CVS Health is seeking a Senior Representative to join our Prior Authorization Administration (PA Admin) department. This role is part of our Quality Testing team and is responsible for completing day‑to‑day quality testing activities, with a primary focus on traditional criteria quality testing and Molina quality testing. The Senior Representative serves as a subject matter expert for the team, ensures accurate audit documentation and reporting, and supports training efforts. This position also offers opportunities for cross‑training within other administrative areas, promoting operational flexibility and continued professional development.
Key Responsibilities Include:
- Perform daily production work related to criteria quality testing and Molina quality testing, ensuring accuracy and compliance with established standards.
- Conduct quality audits, document findings, and provide accurate, timely reporting of results.
- Identify trends, errors, and improvement opportunities, escalating issues as appropriate.
- Act as a Subject Matter Expert (SME) for quality testing processes, criteria review, and department‑specific requirements.
- Assist with onboarding, training, work instruction updates, and ongoing education for team members, including process updates and best practices.
- Provide guidance and peer support to ensure consistent quality outcomes across the team.
- Participate in process improvement initiatives and contribute to the enhancement of quality and efficiency.
- Collaborate with direct leader and team support departmental goals.
- Engage in cross‑training opportunities within the PA Administration department to expand functional knowledge and coverage.
Required Qualifications
- 1 plus years of experience in the CVS Caremark Prior Authorization and Appeals Administration department
- Must be considered in good attendance and performance standing
- Requires flexibility to work various shifts between 8:00 AM and 8:00 PM
Preferred Qualifications
- Experience with PA system setup
- Experience with MS Excel, Word and PowerPoint
- Experience with CAS and/or MedHOK systems
- Experience with Prior Auth and Appeals activities
- Experience with previous project management
- Bachelor’s Degree
Education
High School Diploma or equivalent GED
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$18.50 - $35.29This 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.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.