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.

Position Summary
The MAC team is responsible for all aspects of MAC list maintenance. This includes creating new MAC lists and managing existing MAC lists, uploading MAC prices to the adjudication platform and all MAC related QC processes. The MAC team works closely with the Finance Guarantee team to help ensure client commitments are met by making MAC adjustments as appropriate. The MAC team is also responsible for reviewing and responding to all pharmacy MAC appeals and working with the Legal team to respond to any MAC related complaints from state agencies. In addition, the MAC team monitors pharmacy GER guarantees and making MAC adjustments as needed. The MAC team is also responsible for all MAC related reporting, including client and pharmacy reports.

Responsibilities:

• MAC Pricing Compliance & Inquiry Resolution
  Review and resolve pharmacy inquiries related to Maximum Allowable Cost (MAC) pricing, ensuring compliance with MAC law requirements.

• Data Validation & Source Verification
  Validate pricing and product information using trusted sources such as Medispan, manufacturers, and wholesalers.

• Database Management & Timely Communication
  Accurately update the Pharmacy Inquiry Database and ensure timely responses to pharmacies within established turnaround times (TAT).

• Market Monitoring & Issue Escalation
  Identify changes in marketplace conditions and promptly escalate potential issues to pharmacists to minimize impact on pharmacies and plan members.

• Team Support & Training
  Assist a team of coordinators by answering questions and providing training support as needed.

• IT Implementation Testing
  Monitor and perform testing activities related to IT system implementations to ensure functionality and accuracy.

• Regulatory Inquiry Support
  Research and respond to Department of Insurance (DOI) inquiries, providing accurate and timely information to state regulators.

• Ad Hoc Management Support
  Provide assistance to management with various ad hoc tasks and special projects as assigned.

Required Qualifications:

• 2–5 years of experience in:

Pharmacy benefit management (PBM)

Pharmaceutical pricing or reimbursement

Healthcare compliance or regulatory affairs

Data analysis or financial modeling

Preferred Qualifications:

• Experience with RxClaim platform (AS 400)
• SAS experience
• Bachelor's Degree

Required Qualifications:

Education Associate degree required

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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.

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

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