Medicare Appeals Quality Lead – Associate Manager

CVS Health Corporation; Pennsylvania; Hybrid; USD 47.000 - 102.000; Vollzeit

Benefits dieser Stelle

Medical, dental, vision benefits

Paid time off

Retirement savings options

Wellness programs

Employee discounts

Zusammenfassung

CVS Health Corporation is seeking a Quality Manager to oversee the Medicare Appeals team, drive performance, and ensure rigorous monitoring and reporting. You will mentor staff, coordinate with functional managers, and lead process improvements to support compliant, high-quality appeals operations.

The role requires extensive Medicare Appeals experience, strong communication, and proven leadership. A steady, solutions-focused approach helps you guide the team toward optimal decisions in a

Qualifikationen

• Requires 5+ years in Medicare Appeals.
• Proficient in Microsoft Office applications.
• Knowledge of Appeals workflows and job aids.
• Strong communication skills with feedback ability.
• Excellent time management and prioritization.
• Familiarity with regulatory and accreditation requirements.

Aufgaben

• Oversee Quality staff and develop high-performing teams.
• Coordinate with area managers to ensure consistent monitoring/reporting.
• Manage performance and resources for monitoring needs.
• Recruit, train, and mentor staff; build a strong team.
• Collaborate to identify trends and propose solutions.
• Validate team effectiveness with scorecards and monitoring.
• Present at Appeals team meetings and drive process improvements.
• Be flexible to accommodate team needs with a solutions-based approach.
• Remain approachable and professional, addressing human needs.
• Mentor on processes, problem resolution and critical thinking.
• Liaise with other key business areas as needed.
• Assist in developing and facilitating new training.
• Participate in staff hiring processes.
• Create a positive workspace by recognizing contributions and soliciting input.

Kenntnisse

Medicare Appeals

Microsoft Office

Appeals workflows

Communication

Time management

Regulatory knowledge

Ausbildung

High school diploma / Associate degree preferred

Tools

QuickBase

Jobbeschreibung

CVS Health Corporation is seeking a Quality Manager to oversee the Medicare Appeals team, drive performance, and ensure rigorous monitoring and reporting. You will mentor staff, coordinate with functional managers, and lead process improvements to support compliant, high-quality appeals operations.

The role requires extensive Medicare Appeals experience, strong communication, and proven leadership. A steady, solutions-focused approach helps you guide the team toward optimal decisions in a