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CVS Health Logo CVS Health · IT - Software Development

Senior Manager, Adjudication and Affordability

United States, Woonsocket Employment contract 82940.00 - 182549.00 USD / Year · Job Posted May 30, 2026

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Job Description

The Senior Manager, Adjudication and Affordability is responsible for improving how prescriptions are priced, processed, and filled across the CVS Health ecosystem. This role focuses on identifying and executing cost-saving opportunities, improving prescription workflows, and helping patients understand their most affordable options. This leader partners closely with Pharmacy Operations, Growth, Trade, Contracts, IT, Legal, Compliance, and Digital teams to ensure affordability programs, third-party plan setup, and coordination of benefits are implemented correctly, compliantly, and with the patient experience front and center. This role reports to the Director of Adjudication Innovation and leads a team of adjudication and analytics experts.

Job Responsibility

  • Lead affordability strategies that reduce out-of-pocket costs and prescription abandonment
  • Evaluate new and evolving cost-saving opportunities across the pharmacy ecosystem
  • Guide patients toward the most appropriate and affordable medication options
  • Design scalable and efficient prescription workflows with internal teams and external partners
  • Use claims and performance data to inform decisions and improve outcomes
  • Strengthen CVS Health's value as a transparent and lower-cost pharmacy
  • Serve as a subject matter expert for adjudication logic, coordination of benefits sequencing, and industry standards
  • Ensure pricing, billing, and affordability pathways meet regulatory and contractual requirements
  • Maintain governance standards that balance affordability, compliance, and operational performance
  • Lead digital patient communication strategies across app, web, point of sale, and messaging
  • Reduce confusion and friction throughout the prescription experience
  • Build and lead a high-performing team with strong expertise in adjudication and affordability
  • Promote accountability, analytical rigor, and cross-functional collaboration

Requirements

  • 7 to 10+ years of experience in adjudication, pharmacy operations, PBM operations, or healthcare technology
  • Proven ability to lead complex programs and influence partners without direct authority
  • Strong problem-solving skills with the ability to simplify complex topics
  • Experience working effectively across multiple business functions
  • Excellent written, verbal, and presentation skills
  • Strong understanding of retail pharmacy operations and financial models
  • Advanced skills in Excel and PowerPoint
  • Bachelor's degree or equivalent pharmacy or operational experience

Nice to have

  • Experience leading affordability initiatives such as discount programs, coupons, pricing transparency, or coordination of benefits
  • Experience leading large teams or managing significant business operations
  • Ability to lead in fast-changing, high-pressure environments
  • Experience with user acceptance testing and end-to-end testing
  • Strong background with pharmacy adjudication industry standards

What we offer

  • Medical, dental, and vision coverage
  • Paid time off
  • Retirement savings options
  • Wellness programs
  • Bonus, commission or short-term incentive program
  • Equity award program
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