The Network Products and Pricing team is solely responsible for the development and execution of network and mail pricing for CVS Caremark, which directly impacts the revenue and advancement of this Fortune 7 Company. The Senior Manager will direct the implementation, management and accuracy of claim pricing for CVS Caremark clients, across retail and mail delivery systems and all adjudication platforms. This individual will lead an operations team specific to client pricing, including retail and mail claims pricing, network structure, and adjudication logic.
The Sr. Manager will be an expert in retail and mail pricing, supporting the PBM client base, including but not limited to direct employers, coalition clients, TPA, Health Plan, and Government lines of business including Medicare Part D, Medicaid and Healthcare Exchanges. They will manage and track project tasks and deliverables specific to the quality management of department operations. The Sr. Manager will oversee multiple operational tasks, ensuring quality through documented controls, data management, analytics, and auditable processes. They will develop standard operating procedures and technical tools to improve team efficiency and TATs, while meeting all requirements detailed in SOX, SAS 70, internal and external audits . They will develop expertise in client book of business, network pricing strategies and assist with identifying and executing corporate initiatives and revenue opportunities.
The Sr. Manager will lead and develop a diverse team of Consultants, Sr. Consultants and Advisors, responsible for activities related to implementation, validation, testing and reporting of client pricing as well as management of project activities. The Sr. Manager will coach, lead and work with staff on the development of career paths and leadership skills.
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