We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary
The MAC team is responsible for all aspects of MAC list maintenance. This includes creating new MAC lists and managing existing MAC lists, uploading MAC prices to the adjudication platform and all MAC related QC processes. The MAC team works closely with the Finance Guarantee team to help ensure client commitments are met by making MAC adjustments as appropriate. The MAC team is also responsible for reviewing and responding to all pharmacy MAC appeals and working with the Legal team to respond to any MAC related complaints from state agencies. In addition, the MAC team monitors pharmacy GER guarantees and making MAC adjustments as needed. The MAC team is also responsible for all MAC related reporting, including client and pharmacy reports.
Responsibilities:
MAC Pricing Compliance & Inquiry Resolution
Review and resolve pharmacy inquiries related to Maximum Allowable Cost (MAC) pricing, ensuring compliance with MAC law requirements.Data Validation & Source Verification
Validate pricing and product information using trusted sources such as Medispan, manufacturers, and wholesalers.Database Management & Timely Communication
Accurately update the Pharmacy Inquiry Database and ensure timely responses to pharmacies within established turnaround times (TAT).Market Monitoring & Issue Escalation
Identify changes in marketplace conditions and promptly escalate potential issues to pharmacists to minimize impact on pharmacies and plan members.Team Support & Training
Assist a team of coordinators by answering questions and providing training support as needed.IT Implementation Testing
Monitor and perform testing activities related to IT system implementations to ensure functionality and accuracy.Regulatory Inquiry Support
Research and respond to Department of Insurance (DOI) inquiries, providing accurate and timely information to state regulators.Ad Hoc Management Support
Provide assistance to management with various ad hoc tasks and special projects as assigned.
Required Qualifications:
- 2–5 years of experience in:
Pharmacy benefit management (PBM)
Pharmaceutical pricing or reimbursement
Healthcare compliance or regulatory affairs
Data analysis or financial modeling
Preferred Qualifications:
- Experience with RxClaim platform (AS 400)
- SAS experience
- Bachelor's Degree
Required Qualifications:
Education Associate degree required
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$21.10 - $44.99This 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.
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 people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- 2-5 years experience in pharmacy benefit management (PBM)
- 2-5 years experience in pharmaceutical pricing or reimbursement
- 2-5 years experience in healthcare compliance or regulatory affairs
- 2-5 years experience in data analysis or financial modeling
- Associate degree
- Experience with RxClaim platform (AS/400)
- SAS experience
- Bachelor's Degree
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
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