At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position Summary
The Senior Manager, Pricing will lead a team of 20+ colleagues in the management of pharmacy reimbursement appeals, both generic (MAC) and brand (Non-MAC). In this role, you will ensure the appeals are executed under tight Turnaround Times (TATs) and with high accuracy while making sure the team is appropriately staffed and organized. In addition, you will be responsible for developing and implementing solutions individually and being a lead working with partners to improve and automate processes to increase productivity and fulfill state regulatory changes. You will be leading and coaching the appeal team coordinators as well as guiding other internal business units to resolve issues quickly. The Senior Manager, Pricing is also responsible for working legal and compliance team to ensure state regulatory update are operationalized. This role requires a thorough knowledge of claim adjudication, internal non-MAC related processes, and being a leader working with other internal business units to develop new solutions to meet the ever-increasing number of complex appeal bill compliance requirements. The position will be responsible for quality control process to ensure compliance. What you will do
Want more jobs like this?
Get jobs in Tallahassee, FL delivered to your inbox every week.
- Leads with strategic leadership and guidance to pricing teams, ensuring effective pricing strategies and operations are effectively progressed that improve work area profitability and revenue growth.
- Analyzes pricing data, market trends, and competitive insights to generate actionable recommendations, supporting informed pricing decisions and improving market competitiveness.
- Collaborates cross-functionally with legal, finance, and account teams to align pricing strategies with business goals, enhance value propositions, and optimize revenue opportunities.
- Influences stakeholders through effective communication and negotiation, leveraging pricing expertise and industry knowledge to establish mutually beneficial partnerships and agreements.
- Applies experienced-based pricing knowledge and insights to influence strategic decision-making, contributing to the development of pricing policies, initiatives, and market positioning.
- 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.
- 7+ years relevant work experience
- 5+ years directly leading operations teams
- 1+ years' experience with pharmacy appeal related processes and state regulations, and claims adjudication, including claims adjudication logic
- Excellent leadership skills
- Proficient in Excel, MS Access, Salesforce, and Pharmacy Portal
- Ability to work under tight deadlines
- Strong mathematical problem-solving skills
- Prior PBM Knowledge
- Familiarity with wholesaler invoices
Bachelor's Degree or equivalent experience required.Pay Range
The typical pay range for this role is:$67,900.00 - $199,144.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program.Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.