AVP, Payer Relations Strategy and Execution

CVS Health • Woonsocket, RI

1d

About The Position

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. AVP, Payer Relations Strategy and Execution The AVP, Payer Relations Strategy and Execution is a senior leadership role accountable for sharping CVS Pharmacy’s payer posture for its largest and most complex payer relationships. This role is responsible for designing forward-looking payer strategy, enforcing pricing discipline, and expanding enterprise partnerships beyond transactional negotiations. This is a strategy-first leadership role with targeted but critical negotiation ownership. Success requires anticipatory thinking, independent judgment, and the ability to operate credibly with enterprise executives and sophisticated payer counterparts. Directly responsible for the oversight and administration regarding contract negotiations of rates, terms and conditions with multiple payers (PBMs, clients, third parties) that fall within the annual forecasted financial plan; this includes program parameters, workflow management for many Network programs, such as Performance programs, Medication Adherence, CMRs, and also “umbrella rate” terms such as National Commercial GER/BER and OED and managing through the terms and efforts of quarterly/end-of-year reconciliation efforts by multiple payers/PBMS/Plans. Develop new methods of troubleshooting reconciliations to arrive at creative solutions that helps improve our overall net effective rates. Negotiates and understands the strategic development, coordination, and implementation of the operations and forecasting of financials associated with each contract in order to relay and support the review and analysis of the Finance department data and accurate reporting to meet forecasted projections; Oversight and direction of final contract execution of payer contracts; Creates quality assurance protocol and methodology enhancements to eliminate missed contractual PBM / client guarantees; plan, anticipate and solve for potential adverse impacts such as financial penalties, to help support and uphold specific payer contractual guarantees, including enterprise financial and clinical efforts. Drive collaboration with Legal, Government Affairs, and Payer Relations Finance teams to interrupt Payer negotiation stalemates through creative development of cost assurances and other calculated risk offerings. Negotiate for return of monies through unexpected industry wide pricing changes, adverse supply situations and other pivotal events that if not addressed can negatively impact earnings, patients and other constituencies. Drive new products in the CVS retail pharmacy space (CostVantage) and indirectly support new PBM initiatives to align with the market place and create positive next generation opportunities for overall enterprise financial and strategic value; Directly support contract negotiation and execution of key specialty initiatives in CVS pharmacy and client plan contract arrangements and operational execution, as applicable and aligned with other enterprise initiatives (e.g., biosimilars, LDD/EDD opportunities) Oversight of 3-5 direct reports (Executive Directors, Lead Directors) and 3 – 5 indirect reports (Lead Directors, Account Executives, Senior Managers) who will be responsible for the management and growth of our payer partners, with the primary focus to lead and develop the team to set, drive and align organizational focus and strategy with their assigned payers, and develop internal succession planning for long-term success in negotiating contracts on behalf of CVS Retail, LTC, Clinic, Immunization, and Specialty channels; Create different opportunities within the Payer Value Proposition to troubleshoot financials and continue the relationship to reset through pricing strategies that are new and unique in the market place. Empower direct reports to develop and hone strategic internal and external relationships and engage regularly with internal business partners across the Enterprise.

Requirements

• 10+ years of experience in the PBM, payer, and/or retail pharmacy industry, with strong understanding of healthcare and pharmacy market dynamics, including government and commercial payors, drug benefit design, and cost drivers.
• Experience negotiating PBM and/or retail pharmacy contracts with demonstrated strength in financial evaluation, underwriting, and pro‑forma development.
• Executive‑level consulting experience translating business problems into analytics‑driven solutions with measurable business impact.
• Proven ability to evaluate initiatives based on business value and ROI, supported by strong analytical rigor and quantitative analysis skills.
• Hands‑on analytics experience in retail, healthcare, or related industries, with a track record of deploying analytic capabilities across diverse business functions.
• Strong strategic thinking skills, including the ability to define business problems, develop analytical and financial frameworks, and drive strategic plan development and execution.
• Expertise in interpreting financial data, forecasting, and applying predictive analysis to inform decision-making.
• Demonstrated ability to build, lead, mentor, and develop high‑performing teams while fostering a collaborative, supportive culture.
• Proven success building strong partnerships with cross‑functional and non‑analytic business leaders, including senior executives.
• Exceptional communication skills—written, verbal, and data presentation—with ability to tailor messaging to audiences ranging from technical analysts to executive leadership.
• Strong project management skills with ability to manage multiple initiatives, prioritize effectively, and operate independently while anticipating issues and driving outcomes.
• Ability to work in an executive‑facing environment while balancing individual contributor responsibilities, team leadership, and succession planning.
• Proficiency in Microsoft Office (Excel, PowerPoint, Word); Visio experience preferred.
• Willingness to work extended hours when required.
• Ability to travel up to 40%.

Nice To Haves

• Influence others: Must possess the ability to structure useful guidance around complex and far reaching strategy decisions to influence and guide the decisions made by others.
• Subscribe to a passion for Health Care: A history of work in the health care industry and an ongoing desire to make one of the world’s strongest health care companies even stronger.
• Be a self-starter and see contract negotiations through to completion within an established timeframe
• Manage to a critical path and troubleshoot without losing sight of the end goals
• Maintain customer focus while meeting/exceeding financial expectations
• MBA or Public Health-related, CPhT, Pharm.D. is Preferred

Responsibilities

• Payer strategy and direction Develop and own multi-year strategies for CVS Health’s largest and most complex payer relationships Define negotiation posture, non-negotiables, trade spaces, and escalation principles in advance of contracting cycles Anticipate payer actions, regulatory dynamics, and market shifts 12-24 months ahead Translate enterprise priorities into coherent payer-facing strategues and decisions
• Negotiation leadership and pricing discipline Personally engage in negotiations when senior involvement materially impacts outcomes Establish deal philosophy and governance to prevent exception creep and long-term erosion Ensure negotiations align to enterprise strategy rather than short-term optimization Balance relationship management with disciplined protection of CVS’s economic position
• Enterprise partnership development Expand relationships beyond reimbursement into broader enterprise collaboration Identfy and structure opportunities across services, data, transparency, and affordability Ensure “partnership” initiatives strengthen CVS’s leverage rather than dilute it Partner with internal product and enterprise leaders to bring differentiated offerings to payers
• Cross-functional and executive leadership Partner closelt with Finance, Legal, Trade, Government Affairs, and Product teams Surface disagreements privately with clear options, risks, and consequences Drive alignment early and execute decisively once direction is set Represent Payer Relations credibly in senior executive and enterprise forums
• Team and capability development Elevate the strategic capability of the payer relations organization Shift the team from reactive execution to anticipatory, systems-based thinking Coaching Directors and Executive Directors to operate at enterprise scale Build repeatable frameworks and operating rhythms, reducing reliance on heroics

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Executive