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At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Sr. Manager, Clinical Assumptions

Position Summary:

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.

Additionally, this position will:

+ 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

The successful candidate will have a track record that demonstrates the following abilities: working successfully in a cross-matrix environment, adapting and performing in a dynamic and changing environment, developing and leveraging a comprehensive understanding of CVS Caremark’s enterprise assets, developing a deep understanding of internal and external assumptions, maintaining high levels of customer satisfaction, constantly striving to innovate and improve processes and applying financial and analytical expertise to make informed recommendations and decisions.

Required Qualifications:

+ 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.

Preferred Qualifications:

+ 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

Education:

+ BS Pharmacy or PharmD

+ Licensed Pharmacist

Pay Range

The typical pay range for this role is:

$67,900.00 - $199,144.00

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.

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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

+ **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.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 06/30/2025

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

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.