Full-Time

Manager – Pricing

Confirmed live in the last 24 hours

CVS Pharmacy

CVS Pharmacy

10,001+ employees

Retail pharmacy and healthcare services provider

Healthcare
Consumer Goods

Compensation Overview

$54.3k - $159.1kAnnually

+ Bonus + Commission + Short-term Incentive Program

Senior

Company Historically Provides H1B Sponsorship

Remote in USA

Category
Strategy Development
Business Development
Business & Strategy
Required Skills
Salesforce
Requirements
  • 5+ years relevant work experience
  • 1+ years’ experience with all Pharmacy and state department of insurance appeal related processes and state regulations, and claims adjudication, including claims adjudication logic
  • Bachelor’s Degree or relevant experience required.
  • 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
Responsibilities
  • 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.

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, beauty items, and general merchandise. CVS Health also functions as a pharmacy benefits manager, serving over 75 million plan members, and has a senior pharmacy care business that assists more than one million patients each year. This integrated model allows CVS Health to deliver affordable health management solutions, improving access to quality care and health outcomes while aiming to reduce overall healthcare costs. Unlike many competitors, CVS Health combines retail pharmacy services with clinical care and pharmacy benefits management, positioning itself as a significant player in the healthcare sector with a commitment to enhancing people's health.

Company Stage

N/A

Total Funding

N/A

Headquarters

Woonsocket, Rhode Island

Founded

N/A

Growth & Insights
Headcount

6 month growth

-2%

1 year growth

-2%

2 year growth

-2%
Simplify Jobs

Simplify's Take

What believers are saying

  • The availability of updated flu and COVID-19 vaccines at CVS Pharmacy and MinuteClinic locations nationwide positions the company as a key player in public health initiatives.
  • The Health Zones funding and collaboration with local organizations in Fresno highlight CVS Pharmacy's role in improving community health outcomes.
  • The introduction of a new store brand for snacks, beverages, and groceries could attract a broader customer base and increase in-store sales.

What critics are saying

  • The competitive landscape in the retail pharmacy sector is intense, with major players like Walgreens and Rite Aid posing significant challenges.
  • The expansion into grocery and snack products may dilute CVS Pharmacy's brand identity as a healthcare provider.

What makes CVS Pharmacy unique

  • CVS Pharmacy's integration of digital tools for scheduling vaccinations and accepting walk-ins offers a seamless and convenient experience for customers, setting it apart from competitors.
  • The company's Health Zones initiative, which focuses on community health and access to healthy food, demonstrates a commitment to social responsibility that goes beyond traditional pharmacy services.
  • CVS Pharmacy's recent launch of a new store brand for snacks, beverages, and groceries diversifies its product offerings, making it a one-stop shop for consumers.

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