Full-Time

Senior Manager Project Management

Posted on 1/9/2025

CVS Health

CVS Health

10,001+ employees

Comprehensive pharmacy and healthcare services

Healthcare
Consumer Goods

Compensation Overview

$82.9k - $182.5kAnnually

+ Bonus + Commission + Equity Award Program

Expert

Company Historically Provides H1B Sponsorship

Boston, MA, USA + 15 more

More locations: Houston, TX, USA | Cheektowaga, NY, USA | Austin, TX, USA | Tampa, FL, USA | Dallas, TX, USA | Smithfield, RI, USA | Chicago, IL, USA | St. Louis, MO, USA | Scottsdale, AZ, USA | Ambler, PA, USA | Hartford, CT, USA | Oklahoma City, OK, USA | Phoenix, AZ, USA | Atlanta, GA, USA | Plantation, FL, USA

Category
Project Management
Business & Strategy

You match the following CVS Health's candidate preferences

Employers are more likely to interview you if you match these preferences:

Degree
Experience
Requirements
  • 10+ years claim processing experience required
  • Full understanding of the SCM rate wizard input, non-preferred contracting options, Carve out & grouper tabs.
  • Familiar with Professional Component concept, and EPDB limitations related to same
  • Moderate understanding of EPDB & SCSR: Provider & PBG selection logic; fee schedule & modifier pricing logic
  • Demonstrated strong understanding of Strategic Pricer logic and concepts
  • Excellent verbal and written communication skills
Responsibilities
  • Oversee a team responsible for researching and analyzing Strategic pricing system functionality & enhancements
  • Support the analysis of Aetna’s contract rate tools to identify operational improvement opportunities
  • Provide project support which entails assessing risks both up & down stream, formulating business requirements, working in partnership with IT counterparts
  • Assemble testing strategies, validate testing results, including review and sign-off during code implementation
  • Formulate training techniques, create materials, and facilitate in partnership with other systems
  • Contribute to maintenance/update all team training materials, including formulation of contract/claim examples, system mock-ups, and depiction of pricing outcomes
  • Standard Service Grouping Maintenance- coordinate with various service grouping content owners, analyze code sets, implement maintenance requests, then audit for accuracy
Desired Qualifications
  • BIR/ Provider Solutions background
  • Network Contracting and/or SCM Contracting support experience
  • Familiarity with the various CMS payment methodologies supported by Strategic Pricer via Burgess software
  • QuickBase user experience

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. The company serves individual consumers, businesses, and communities, offering prescription medications, over-the-counter health products, beauty items, and general merchandise. CVS Health also functions as a pharmacy benefits manager, managing health plans for over 75 million members, and provides specialized care for seniors and patients requiring specialty medications. This integrated approach allows CVS Health to enhance access to healthcare, improve health outcomes, and reduce costs. Unlike many competitors, CVS Health combines retail pharmacy services with clinical care, making it a significant player in the healthcare sector with a goal of helping people achieve better health.

Company Stage

Debt Financing

Total Funding

N/A

Headquarters

Woonsocket, Rhode Island

Founded

1963

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Simplify's Take

What believers are saying

  • Expansion of telehealth services allows CVS to reach more patients remotely.
  • Increased consumer interest in wellness boosts demand for CVS's health-related products.
  • The trend towards value-based care aligns with CVS's integrated healthcare approach.

What critics are saying

  • Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.
  • The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.
  • The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

What makes CVS Health unique

  • CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.
  • The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.
  • CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

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Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

INACTIVE