Manager, Pharmacy Analytics and Contract Compliance

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
 
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary

The Manager, Pharmacy Analytics and Contract Compliance will act as a subject matter expert on current contract terms and rate reconciliation data to deliver clear, actionable, insights and reporting to our Payer Relations partners and external PBM clients. An individual in this position serves as an integral member of the Payer Reimbursement Analytics Team, reporting to the Senior Manager – Contract Compliance.

An individual in this role will be accountable for the management of a book of multiple PBM Payers on a monthly/quarterly cadence. Analysts will manage PBM impact in close coordination with the broader Payer Relations Financial Planning and Analysis team, as well as Payer Relations Directors.

As the Pharmacy Analytics and Contract Compliance Manager, you will play a key role in providing senior management with the information it needs to make critical business decisions. Success in this role requires an individual to be accountable, adaptable, time-efficient, possess strong critical thinking and analytical skills, and effectively communicate at all levels of the organization.

The Pharmacy Analytics and Contract Compliance Manager is responsible for several financial, analytical, and reporting responsibilities including:

• Managing an assigned book of PBM payer data reconciliations at a monthly and/or quarterly cadence.
• Collaborating and sustaining business relationships with Payer Relations Directors and other Pharmacy Analytics and Contract Compliance Analysts on PBM compliance management.
• Providing insights to senior leadership on process improvements, leveraging new technology and improved data sets to refine existing reporting and reconciliation processes.
• Coordinating and clearly communicating impact between adjudication and overall pricing guarantees to senior leadership and Payer Relations Directors.
• Partner with Payer Relations Directors to negotiate contract settlements with data-driven insights.
• Individuals will also collaborate with IT partners for data infrastructure enhancements and development for ongoing process improvement.

The ideal candidate will have:

• Combination of business and technical/analytical expertise to generate customized, actionable insights in a data-driven and deadline-oriented environment.
• Strong analytical and quantitative skills; outstanding strategic thinking and problem-solving skills. 
• Ability to develop a deep understanding of PBM contract language, data requirements and reconciliation processes across multiple lines of business as well as serving as a SME and data steward for other Payer Relations Analysts, as well as Payer Relations Directors.
• Ability to identify complex problems and develop actionable solutions through data analysis and observation.
• Experience building financial modeling, measuring financial impact, identifying trends and anomalies, drawing conclusions from data, as well as problem-solving and troubleshooting.

Required Qualifications

• 3+ years of professional work experience. 
• 3+ years of data analytics work using Excel/Access, other business intelligence or reporting tools.
• 1+ years financial modeling experience is a significant plus.

Preferred Qualifications

• Experience with SQL, Salesforce, Foundry, Tableau, Power BI strongly preferred.
• Ability to learn new tools and skills quickly is strongly preferred.
• Excellent written and oral communication and strong presentation skills. 
• Ability to quickly learn new businesses processes and identify key drivers of performance. 
• Detail-oriented and able to manage multiple projects simultaneously, prioritizing work, and communicating results in a manner that is clear, logical, consistent, and effective.
• Results driven, with a desire to work in a dynamic environment that values collaboration, integrity, and accountability.

Education

Bachelor’s Degree in Finance, Business Analytics, Economics, Public Health, or related field.

Pay Range

The typical pay range for this role is:

$63,300.00 – $139,200.00

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. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  
 
For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 04/26/2024