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Position Summary
The Manager, MPPS Pharmacy Policy Management is responsible for supporting the development, operationalization, monitoring, and continuous improvement of Medical Pharmacy (Med Rx) policies across Commercial, Medicare, and Medicaid lines of business. This role supports MPPS leadership to ensure medical pharmacy policies are clinically appropriate, operationally executable, and consistently applied. They oversee pharmacy policy management which includes coding accuracy, business rule translation, quality assurance, and regulatory compliance activities supporting provider-administered medications, specialty pharmaceuticals, biosimilars, infusion therapies, and emerging drug technologies. The position is accountable for driving operational excellence, reducing policy-related defects, and improving claim payment accuracy.
Medical Pharmacy Policy Ideation
- Lead the identification of new and emerging pharmacy policy opportunities, standardizing across lines of business.
- Develop detailed business requirement documents for pharmacy policies.
- Ensure accurate translation of policy intent into claims processing rules, utilization management workflows, and reimbursement methodologies.
- Support policy enablement processes, as assigned.
Quality Assurance & Defect Remediation
- Align coding and reimbursement logic with Medical Pharmacy policy intent.
- Establish quality monitoring programs supporting Medical Pharmacy policy implementation and operational execution.
- Lead root cause analyses for policy defects, configuration issues, coding inaccuracies, and operational failures for pharmacy policies.
- Ensure audit readiness and maintenance of supporting documentation.
Analytics & Performance Management
- Develop and monitor key performance indicators (KPIs) supporting Medical Pharmacy policy effectiveness.
- Utilize data analytics to identify utilization trends, operational gaps, coding defects, and cost-saving opportunities.
- Support internal audits, external audits, compliance reviews, and corrective action initiatives.
May reside anywhere in the US
Required Qualifications
- 3+ years of policy & business analytics experience.
- Certified Professional Coder (CPC), Certified Pharmacy Technician (CPhT), or agreement to obtain CPC within one year of hire in the role.
- Experience partnering with cross-functional stakeholders across clinical, operational, and technical teams.
- Experience with translating data analytics to insights.
Preferred Qualifications
- Knowledge of specialty pharmaceuticals, provider-administered drugs, biosimilars, infusion therapies, and emerging therapeutic categories.
- Knowledge of Medicare Part B drug management and reimbursement.
- Experience with specialty drug cost-management programs and affordability initiatives.
- Knowledge of Payment Integrity and medical drug claim editing platforms.
Education
- Bachelor’s degree in pharmacy, healthcare administration, or related discipline or equivalent combination of education and relevant experience.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$54,300.00 - $145,860.00This 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
- 3+ years of policy and business analytics experience
- Certified Professional Coder (CPC), Certified Pharmacy Technician (CPhT), or agreement to obtain CPC within one year of hire
- Experience partnering with clinical, operational, and technical stakeholders
- Experience translating data analytics into insights
- Knowledge of specialty pharmaceuticals, provider-administered drugs, biosimilars, infusion therapies, and emerging therapeutic categories
- Knowledge of Medicare Part B drug management and reimbursement
- Experience with specialty drug cost-management programs and affordability initiatives
- Knowledge of Payment Integrity and medical drug claim editing platforms
- Bachelor's degree in pharmacy, healthcare administration, or a related discipline, or equivalent education and relevant experience
CVS Health Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about CVS Health and has not been reviewed or approved by CVS Health.
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Healthcare Strength — Health coverage includes medical, dental, and vision with HSA-eligible options, free preventive care, virtual care, and access to MinuteClinic services. Mental-health resources such as counseling support are emphasized, and coverage is often considered solid for full-time colleagues.
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Retirement Support — A dollar-for-dollar 401(k) match up to 5% after one year and an Employee Stock Purchase Plan are consistently highlighted in Total Rewards materials. Feedback suggests retirement programs are a meaningful strength within the overall package.
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Wellbeing & Lifestyle Benefits — Wellbeing offerings include up to 20 no-cost counseling sessions per issue, backup care, tuition assistance, and substantial in-store discounts, alongside broader wellness tools. These everyday perks expand value beyond base pay and can be especially meaningful for full-time schedules.
CVS Health Insights
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.
