Off Phone Quality Manager

Specialty Pharmacy Off-Phone Audit Manager

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

The Specialty Pharmacy Off-Phone Audit Manager leads the internal audit function for CVS Specialty's off-phone and administrative operations. The manager will provide strategic leadership to a team of supervisors, and the team they support, of analysts, by setting clear expectations, fostering professional development, and ensuring accountability for performance outcomes aligned with organizational goals. This role oversees the planning, execution, and reporting of audits using Verint live monitoring and screen capture tools, ensuring compliance with regulatory standards, internal protocols, and driving continuous improvement in operational efficiency, patient safety, and service quality. It will be imperative that this leader possesses the skills to develop and implement the annual audit plan for pharmacy task functions including intake, benefits verification, order scheduling, prior authorization management, clinical reviews, as well as additional off-phone and administrative operations critical to specialty pharmacy services. This leader will ensure all pre-shipment issues are corrected to mitigate financial impact. This position requires strong leadership, analytical skills, and a deep understanding of auditing principles and pharmacy operations. This strategic role directly influences the key business decisions, drives increased productivity, and impacts the effectiveness and efficiencies within operations.

Required Qualifications :

• 5+ years in internal audit, quality assurance, or pharmacy operations
• 5+ years in a leadership or management role with exempt & non-exempt direct reports
• Experience with Verint or similar live monitoring, screen capture audit platforms
• Experience in specialty pharmacy and payer-specific workflows
• Strong analytical skills with proficiency in data analysis tools and techniques
• Ability to process and synthesize quantitative and qualitative data to derive actionable solutions
• Data analysis skills, including the ability to wrangle and analyze large structured and unstructured datasets (Excel and more advanced analytical techniques)
• Engaging and driving business owners to address and resolve project risk or issues
• Power Point Executive level presentations
• Understand business process improvement, project management and quality practices
• Excellent communication skills, with the ability to present data insights clearly to diverse audiences
• As a SME around business and data driven projects; share and drive the offload of knowledge with team members
• Ability to be a mentor to less experienced Business Analyst and team members to drive compliance for best practices, methods, standards, and processes
• Ability to prioritize and meet deadlines with tight timeframes

Preferred Qualifications :

Six Sigma Certification

Education :

High School Diploma or General Equivalent Development (GED)

Anticipated Weekly Hours :

40

Time Type :

Full time

Pay Range :

The typical pay range for this role is : $54,300.00 - $159,120.00

Great benefits for great people :

Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

We anticipate the application window for this opening will close on : 10 / 31 / 2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex / gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.