CVS Health logo
CVS Health

Bringing our heart to every moment of your health.

Manager, Pricing

ManagerManagerFull TimeRemoteSeniorTeam 10,001+Since 1963H1B No SponsorCompany SiteLinkedIn

Location

Texas

Posted

3 days ago

Salary

$54.3K - $145.9K / year

Seniority

Senior

Bachelor Degree5 yrs expEnglish

Job Description

• Leads with strategic leadership and guidance to pricing teams, ensuring effective response to pharmacy and state department of insurance (DOI) appeals are effectively reviewed and responded. • Partner with legal to disposition pharmacy complaints and appeals that come through state agencies • Leads and owns the process and work instruction documents that comply with state laws and meets CVS compliance • Leads and participate in state appeals audit and exam. • Provides the information to state DOI on the inquiries. • Interprets and drafts responses to state DOI inquiries and works with CVS legal team to respond to inquiries. • Collaborates cross-functionally with legal, compliance, network and other teams to manage the pricing appeals. • Influences stakeholders through effective communication and negotiation, leveraging pricing expertise and industry knowledge to establish mutually beneficial partnerships and agreements. • Networks with industry professionals through attending events and conferences related to company objectives, and participating in industry forums, monitoring emerging trends, and keeping updated on critical regulatory changes, ultimately improving innovation and maintaining industry leadership • Counsels and mentor pricing team members, providing guidance and support to enhance their pricing skills and professional development. • Delivers pricing solutions and recommendations that drive profitability and revenue optimization and contribute to the overall financial success of the organization.

Job Requirements

  • 5+ years relevant work experience in finance, pricing, legal, pharmacy or similar discipline
  • 1+ years’ experience with all Pharmacy and state department of insurance appeal related processes and state regulations, and claims adjudication, including claims adjudication logic
  • Proficient in Excel, MS Access, Salesforce, and Pharmacy Portal Adjudication system experience
  • Strong mathematical problem-solving skills
  • Prior PBM Knowledge
  • Familiarity with wholesaler invoices
  • Ability to work under tight deadlines
  • Excellent Communication, interpreting, writing and leadership skills
  • Ability to prioritize, organize, and manage DOI requests
  • Bachelor’s Degree or relevant experience required.

Benefits

  • Affordable medical plan options
  • 401(k) plan (including matching company contributions)
  • Employee stock purchase plan
  • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
  • Paid time off
  • Flexible work schedules
  • Family leave
  • Dependent care resources
  • Colleague assistance programs
  • Tuition assistance
  • Retiree medical access
  • Many other benefits depending on eligibility.

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