Sr Manager, Clinical Assumptions, CVS Health

CVS Health

Location:
United States

Category:
Health and Beauty

Contract Type:
Not provided

Salary:

67900.00 - 199144.00 USD / Year

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Job Description:

As Sr. Manager, Clinical Assumptions, you will join the Pharmaceutical Forecasting and Analysis team supporting the unified PBM Connected Ecosystem to drive accountability and accuracy across the Caremark Organization. The Sr. Manager, Clinical Assumptions will play a key role in developing, supporting and maintaining PBM Assumptions. In this role you will act as a subject material expert in the Clinical field driving accuracy in financial modeling of the Underwriting Ecosystem by connecting with Business Process Owners and Data Architects to emulate future member behavior with the financial modeling. Primary responsibilities include coordinating with Formulary Management to stay abreast of upcoming strategic changes and decode their financial impact, drive accurate modeling by providing clinical guidance when needed on therapeutic equivalencies or interchangeability, and act as a representative of the Client Financial Analysis and Optimization (CFAO) organization with Trade & Medical Affairs as needed.

Job Responsibility:

Partner with Business resources to gather, refine and evaluate new clinical assumptions that influence the business
Foster strong relationships within the PBM Ecosystem to elevate accurate financial stewardship as it related to clinical assumptions
Support discussions that are highly complex
Drive results utilizing durable and automation focused solutions
Prioritize effectively and efficiently to meet internal and external customer needs
Support the translation market dynamics to usable business intelligence
Participate in peer reviews of high complex data requests to validate that modeled data and related analytic deliverables match and satisfy business requirements
Assist in ad-hoc analysis

Requirements:

7+ years professional clinical and/or financials experience, preferably within a PBM or health plan
1+ years experience working with health plans, employer clients, or coalitions/TPAs, with multiple lines of business with different funding arrangements
Able to travel up to 10% of the time
Expertise in Utilization Management and Formulary Management
Knowledge and experience with Microsoft applications (Excel, Power Point, Word, Outlook, Teams)
Strong understanding of, or experience with, internal and external facing pricing and analytics teams
Ability to innovate, develop, and implement new products or solutions requiring collaboration with internal partners
Demonstrated success developing effective relationships with key internal partners across the enterprise
Knowledge of relational databases and warehouses, advanced SQL, VBA, OLAP and SAS skills
Experience managing complex projects in a matrix environment
Ability to summarize complex pharmaceutical findings and support recommendations in presentations to Executive Leadership
Ability to work independently in a fast-paced environment and manage tight deadlines
AMCP Fundamentals of Managed Care Pharmacy Certificate or similar professional advancement
Previous PBM Pricing, Underwriting, Data analytics or Financial Analysis experience
BS Pharmacy or PharmD
Licensed Pharmacist

Nice to have:

Expertise in Utilization Management and Formulary Management
Knowledge and experience with Microsoft applications (Excel, Power Point, Word, Outlook, Teams)
Strong understanding of, or experience with, internal and external facing pricing and analytics teams
Ability to innovate, develop, and implement new products or solutions requiring collaboration with internal partners
Demonstrated success developing effective relationships with key internal partners across the enterprise
Knowledge of relational databases and warehouses, advanced SQL, VBA, OLAP and SAS skills
Experience managing complex projects in a matrix environment
Ability to summarize complex pharmaceutical findings and support recommendations in presentations to Executive Leadership
Ability to work independently in a fast-paced environment and manage tight deadlines
AMCP Fundamentals of Managed Care Pharmacy Certificate or similar professional advancement
Previous PBM Pricing, Underwriting, Data analytics or Financial Analysis experience

What we offer:

Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility

Additional Information:

Job Posted:
May 14, 2025

Expiration:
June 30, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Sr Manager, Clinical Assumptions