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
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
  • Bachelor's degree preferred/specialized training/relevant professional qualification.
Responsibilities
  • oversee a team responsible for researching and analyzing Strategic pricing system functionality & enhancements
  • delineation of any other interfacing or manual manipulation altering the price
  • Validation of theory, when claim reports are furnished from other business areas
  • support the analysis of Aetna’s contract rate tools to identify operational improvement opportunities/validate a financial comment is needed
  • formulating business requirements
  • working in partnership with our IT counterparts
  • assembling testing strategies
  • validating testing results, including review and sign-off during code implementation
  • formulation of training techniques, creation of the materials, and facilitation 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
  • explain complex concepts in laymen's terms, as well as furnish visual representations of the concepts
  • coordinate with various service grouping content owners, analyze code sets, implement maintenance requests, then audit for accuracy
  • coordinate with business partners, including Provider Advance notification when off cycle code changes will be implemented

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. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines retail pharmacy services with a pharmacy benefits manager and senior care services, making it a comprehensive provider in the healthcare sector. The company's goal is to enhance access to quality care and support people in achieving 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