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

Job Purpose and Summary:

CVS Health is on a mission to transform healthcare. With a shared purpose to help people on their path to better health, we are finding new ways to care for our communities, leveraging our brick-and-mortar footprint of 9,000+ stores. At the heart of this strategy are the 180,000+ store colleagues who build unmatched human connections with our customers every day. As we, seek to simplify a complex healthcare system for the patients we serve, while delivering disruptive innovation at a rapid pace, thoughtful communications that engage, inspire, and activate our colleagues across multiple channels are increasingly essential. 

The position will ensure connectivity to standard adjudication services, with focus on performance, reliability, and parity. As a member of the Adjudication Performance team, you will be responsible for facilitating effective solutions related to the adjudication and processing of pharmacy claims and newly expanded healthcare services. Create and ensure custom solutions are implemented and tested according to requirements, support optimization of the existing vendor product portfolio and new product development—enabling data-driven strategic decision-making to identify new revenue opportunities.

The Manager, Adjudication Vendor Solutions will work cross-functionally with both internal and external partners to inform, influence, and design solutions, technology, tools, and processes that simplify billing of products/services and remove friction from the system—thereby enabling access to care for our patients, simplifying processes for our colleagues, and delivering value to the enterprise. This position requires strong analytical, communication, and collaboration skills to be able to influence internal and external business partners. This role will report to the Sr. Manager, Adjudication Performance team, and will play an integral part in driving operational efficiencies and compliance for the enterprise.

Partner with internal and external partners to implement new initiatives /product enhancements that will improve the pharmacy store colleague experiences and address customer needsCollaborate with cross-functional teams, including Adjudication, Payer relations, IT, pharmacy operation teams, and other stakeholders to deliver and track high-impact solutionsLead across all phases of new product implementation or product enhancement, ranging from initial business case development through launching solutions to our customers and colleagues.Support our pharmacy colleagues and core retail business via report monitoring and colleague outreaches

Strategic Planning

Leads across all phases of new product/or product enhancements, ranging from creating initial business cases through launching solutions to our colleagues and customers.Drive operation excellence for pharmacy/medical billing working with internal and external stakeholders, program development, including initial business case development through launching solutions to our customers and colleagues.Facilitates the creation of field facing materials with cross-functional Communications partnership for key touchpointsPartners with Senior Manager to communicate plans, risks, and opportunities from working team up to leadership.Supports the Senior Manager in developing an effective communication strategy for alerting both internal and external leaders of anticipated changes, partnering with communication as neededCreate near and longer-term adjudication technology strategic roadmap, taking inputs from multiple sources to influence internal and external stakeholders in the creation of novel solutions and programs which target emerging healthcare / billing opportunities

Delivers Results

Optimize value driving portfolio of adjudication services, using solid business cases that determine the risk and value with expanding services or implementing new solutions/products.Continually evaluates product performance against KPIs and identify opportunities for improvement to Senior Manager based on performancePerform data analysis on new/existing solution to discover new opportunities and monitor key processes for implemented solutions.Optimizes and level sets expectations with stakeholders by partnering closely with Store Operations leaders, Retail Field Leadership, IT, digital and our portfolio managers to ensure appropriate levels of support and collaborationWork cross-functionally with CSC partners to develop strategies and action plans to mitigate identified risks and opportunities tailored to the specific needs of pharmacy business unit, as needed.Development of billing/vendor solutions that enable business growth/new healthcare services, working cross-functionally to prioritize, structure timelines, develop project plans, align stakeholders, and incorporate feedback in service of driving successful outcomes

Stakeholder Influence and Change Management

Collaborates with cross-functional teams, including IT, digital teams, pharmacy operation teams, and other stakeholders to deliver high-impact solutionsLeverages data, insights, and analytics to influence stakeholders and makes recommendations as appropriate Be an advocate for our patients and Retail store colleagues, identifying opportunities to reduce patient out-of-pocket expenditure at no cost to the enterprise, promote medication adherence and customer satisfaction

Ad-Hoc Analysis

Supports our pharmacy teams and core business partners utilizing reporting and analysisAdapt reporting to inform strategies to identify trends communicating those to the right partners as needed.Translates data insights into meaningful insights and actions

Required Qualifications

2+ years of experience with pharmacy claims adjudication and NCPDP standards3+ years of analytical experience within pharmacy, healthcare, managed care, or related fieldAttention to detail, strong drive to ensure the integrity of underlying data and reportsAbility to communicate and influence mid-level managers (Director and above), as demonstrated by 2+ years of experience creating and delivering leadership-facing materials and presentationsProven ability to collaborate with internal and external partners2+ years of experience using advanced Excel, PowerPoint skills and other MS Office ApplicationsAbility to make decisions / recommendations under pressure and consistently deliver results on tight timelinesAbility to develop content and present to senior leadership and cross-functional partners with a high degree of autonomyExperience building and presenting business cases to address complex business problems, requiring multi-phased strategies to accomplish goalsDemonstrated growth mindset and willingness to learn and accept feedbackProven track record of high performanceExpertise leveraging MS Office Suite, including advanced Excel and PowerPoint capabilitiesCollaborate cross functionally with leaders and colleagues’ enterprise wide to solution, implement, and drive results.Plan and execute short- and long-term goals.Regular and reliable attendance during normal working hours, as established by the leaderAny additional tasks as directed by supervisor or managerSelf-directed individual requiring little directionStrong interpersonal skills as demonstrated by successful collaboration to achieve shared goalsStrong communication skills in both formal and informal writing and speechDemonstrating strong attention to detail and follow through with commitments.Travel requirements – up to 10% travel expected, based on needs of the business

Preferred Qualifications

3+ years of experience working with NCPDP standards and product implementation3+ years engaging and inspiring teams to achieve both short-term, and long-term goals.High level of attention to detail and ability to manage multiple assignmentsExperience in documenting IT requirements and summarizationExperience with administrative claims data such as pharmacy or medical claimsExperience in Retail PharmacyExperience in Excel, PowerPoint, and other MS Office Applications

Education

Bachelor’s degree, or equivalent experience

Pay Range

The typical pay range for this role is:

$66,330.00 - $145,860.00

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 Benefits | CVS Health

We anticipate the application window for this opening will close on: 01/23/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.