Senior Representative, Clinical Support

CVS Health•Work At Home-Texas, TX

About The Position

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.

Requirements

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

Nice To Haves

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

Responsibilities

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.