Senior Manager, Pharmacy Adjudication and Affordability - Managed Care

CVS Health; Woonsocket (RI); On-site; USD 82,940 - 182,549; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Senior Manager, Adjudication and Affordability to enhance prescription pricing and workflows across its ecosystem. This position focuses on cost-saving opportunities while collaborating with various departments to ensure compliance and improve patient experiences.

The ideal candidate will have 7-10 years of relevant experience, strong leadership skills, and a bachelor's degree or equivalent. Great benefits, including medical and retirement options, are offered to eligible employees.

Qualifications

• 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.

Responsibilities

• Lead affordability strategies that reduce out‑of‑pocket costs and prescription abandonment.
• Design scalable and efficient prescription workflows.
• Serve as a subject matter expert for adjudication logic and benefits sequencing.

Skills

Leadership

Problem-solving

Communication Skills

Data Analysis

Education

Bachelor’s degree or equivalent pharmacy or operational experience

Tools

Excel

PowerPoint

Job description

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 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.

Key Responsibilities

Patient Affordability and Access

• 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

Prescription Workflow and Operations

• 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

Compliance and Governance

• 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

Patient Communication

• Lead digital patient communication strategies across app, web, point of sale, and messaging
• Reduce confusion and friction throughout the prescription experience

Leadership and Talent Development

• Build and lead a high‑performing team with strong expertise in adjudication and affordability
• Promote accountability, analytical rigor, and cross‑functional collaboration

Required Qualifications

• 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

Preferred Qualifications

• 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

Education

Bachelor’s degree or equivalent pharmacy or operational experience

Pay Range

$82,940.00 - $182,549.00

This 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. This position also includes an award target in the company’s equity award program.

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.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Application Deadline

We anticipate the application window for this opening will close on: 05/31/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.