Medicaid Grievance & Appeals Business Consultant

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.

Position Summary

As our Medicaid Grievance & Appeals Business Consultant you will develop and implement strategies and policies to direct our operations, subsidiaries, major projects and functional groups. You will help our business units – and our company – meet corporate objectives and compete more successfully in the marketplace.

You will design enterprise wide and/or cross-functional solutions to address business problems. This work results in initiatives that significantly impact company strategy enabling Aetna to be competitive in the marketplace and effectively serve its customers. You will partner with business owners to optimize the achievement of strategic business objectives, to include profitable growth and improved organizational effectiveness. Focus includes one or more of the following:

• Management consulting, business process/project consulting, financial strategic analysis, mergers and acquisitions, strategic business planning, and, or risk management consulting) Involved in initiative planning, ongoing client relationship management and satisfaction for assigned initiatives that impact the delivery of products and services to the internal and external environment (See Family Summary).
• Collaborates with external vendors, external consultants, consulting team members and/or matrixed staff as required in support of initiatives. Accountable for transferring knowledge, best practices (external and internal), methodology and tools to client organizations.
• Participates as a team member, may be responsible for concurrent initiatives or act as team lead for less complex projects based on resource requirements.
• Supports holistic solutions and/or key strategic plans. Proactively identifies opportunities for improvement within assigned initiatives
• Conducts thorough business case and external customer value analysis to determine selection, prioritization positioning and approach for broadest range of potential solutions (e.g., outsourcing, process improvements, technology solutions)
• Participates and supports metrics integration and execution for optimal results. Shares joint accountability for initiative’s return on investment
• Communicates compelling and concise results to empower client groups in decision making process regarding project opportunities
• Participates in initiative planning as required. Supports engagement using a disciplined repeatable methodology
• Designs, develops interventions and facilitates work sessions. Develops and delivers all required analysis, reporting and presentation materials
• Gathers, analyzes and synthesizes business intelligence to drive achievement of strategic business objectives
• Builds and utilizes diverse internal and external networks, as appropriate, for data gathering and best practice identification.
• Leverages internal and external networking to drive optimal initiative results and knowledge/best practice transfer

Required Qualifications

• 3 to 5 years Grievance and Appeals experience
• Experience with one or more of the following methodologies: management consulting, project consulting, business process consulting, financial strategic analysis, mergers and acquisitions, strategic business planning, and/or risk management consulting.
   

Preferred Qualifications

• 3 to 5 years of external audit experience
• We support a hybrid work environment. If selected and you live near a suitable work location you may be expected to comply with the hybrid work policy. Under the policy, all hires for in-scope populations should be placed into a hybrid or office-based location, working onsite three days a week. 

Education

• Bachelor’s degree or equivalent work experience

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Pay Range

The typical pay range for this role is:

$60,300.00 - $132,600.00

This pay range represents the base hourly rate or base annual full-