Manager- Medical Economics

CVS Health • Blue Bell, PA • 4h ago

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

This role leads complex medical economics analyses supporting Non-Participating (Non-Par) pricing, No Surprises Act (NSA) compliance, audits, and strategic initiatives, translating highly technical data into clear insights for actuarial, legal, and business stakeholders to support the overarching Medical Economic mission statement of reducing medical costs and medical costs trends to provide more affordable healthcare to Aetna and CVS Health members while improving quality and access.

As part of the Medical Economics National team, you will have the opportunity to present key trends, financial performance, tools and analyses with a broad MEU audience (including direct exposure to VP-level leadership). The MEU National team is accountable for working collaboratively across MEU to analyze, draw conclusions, and communicate the financial impact resulting from changes in Aetna's network provider agreements.

This position plays a critical role in ensuring pricing defensibility, regulatory compliance, and financial integrity in one of the most complex and scrutinized areas of healthcare reimbursement.

Individual contributor that applies wide-ranging knowledge and experience of own job area within business unit or function, and may have advanced knowledge and practical experience of specific technical areas applied within the @context of a similar industry or @type of organization.

Serve as a subject-matter expert for Non-Par pricing methodologies, including Fair Health benchmarks, Vendor Programs, the Aetna National Advantage Program (NAP), and Medicare-based comparisons.

Own medical economics inputs and assumptions for non-par audits and benefit re-pricing exercises.

Respond to time-sensitive executive and client inquiries, distilling complex findings into concise, defensible summaries

Requires strong communication skills, creating an environment of teamwork and continual process improvement internal to MEU and external constituents.

Provides Local Market support to Medical Expense Review teams on non-par topics

Required Qualifications

Bachelor's degree along with 3 - 5 years experience and knowledge of:

Complex data collection, modeling & analysis.

Experience working with Excel and Web-based query tools (SQL, BigQuery, etc.).

Prioritizes & manages multiple projects while managing customer expectations and business priorities.

Work collaboratively and build relationships with customers.

Preferred Qualifications

Knowledge of:

Extensive knowledge of managed care and how provider reimbursement policies relate to the control of medical claims costs.

Full comprehension of provider contracts and the potential impact the regulatory/legislative environment has on reimbursement strategies.

Understanding of internal and external database applications.

Knowledge of market-place delivery (understanding of provider relationships).

Skill in:

Advanced communication/presentation skills.

Advanced software and programming skills.

Education

Bachelor's Degree in business, finance, or related field OR equivalent work experience.

Anticipated Weekly Hours

Time Type

Full time

Pay Range

The typical pay range for this role is:

$60,300.00 - $203,940.00

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.

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: 05/29/2026

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

CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran - committed to diversity in the workplace.

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