Decision Scientist - Trend and UM Strategy and Management

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
 
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary

Do things that matter. Diabetes, congestive heart failure, COPD, back pain, asthma, pulmonary fibrosis, chronic kidney disease, Alzheimer's, multiple sclerosis, cancer... everyone knows someone affected by these conditions. Our goal is to decrease cost and improve health for members with chronic disease. We do this by using data science and advanced analytics (e.g., condition specific predictive models and clinical data mining) to improve their care journeys and outcomes, focusing on the right members getting the right interventions at the right time. 

Mission aligned to improve health. With 1,000+ health hubs, 1,100+ minute clinics, 23M+ lives insured by Aetna, and 100M+ lives with pharmacy benefits coverage through Caremark. With this unique collection of assets, CVS Health has an unparalleled platform to make a significant impact on healthcare in the US and beyond. 

We have actual big data. The combined data assets of CVS are massive: medical and pharmacy claims, health care records, commercial store, and transactional data for 100M+ members. The scale of our data will allow you to design and test powerful experiments and challenge yourself to innovate in ways that others simply cannot. 

An elite team. You’ll be joining a team of MDs, PhDs, MBAs, and top analytics professionals that bring their clinical, technical, and economic experience to bear on some of the toughest targets in healthcare. 

Focus of the Position (PBM Analytics) 

Our PBM Analytics team is tasked with optimizing our ability to engage with our 100M+ Caremark members to help them make better healthcare decisions, particularly relating to the medications they take. Our goals are to improve clinical outcomes and to help members gain more transparency into the healthcare system so that they can save money and have better experiences. To do this we’ve developed a leading capability that combines data science, agile marketing, behavioral economics, large scale experimentation, and optimization of our digital capabilities. Through this we message millions of members each year about real challenges they face and help them become healthier or save money – we drive tangible and meaningful impact for our members.

• This role is required to fulfill the Enterprise goals of effective cost management through managing the aggregate financial impact of PBM products, initiatives, and contracts on pharmacy cost trend.
• The team’s goal is to provide timely, accurate, actionable data and analysis for utilization and unit cost management to reduce pharmacy cost for our clients: quantifying how our various products and programs (e.g., utilization management) are impacting pharmacy cost trends, and helping prioritize actions that would lead to further cost improvements across Commercial and other lines of business.
• Support the evaluation and implementation of enterprise initiatives to respond to pharmacy cost pressures and mitigate unfavorable drivers of business performance.
• Support regular trend analyses and material development for department reporting and meetings.
• Deliver performance evaluation and business-impacting recommendations for cost savings analytics.
• Assist in identifying critical pharmacy cost issues and design and recommend solutions to business problems to staff, senior Executive leadership, and key business partners
• Work cross-functionally across a diverse stakeholder group including: Product, Clinical, Finance, Trade, Medical Economics, Data Science, and Actuarial

Required Qualifications

• 1+ years with Data Science, Healthcare Analytics, Medical/Pharmacy Cost Analytics, Actuarial Science
• 1+ years working in a role with competing priorities and working cross-functionally

Preferred Qualifications

• Familiar with or is willing to learn some of the most popular advanced analytics such as machine learning, statistical analyses, and predictive modeling.
• Strong analytical ability and familiarity with advanced financial and healthcare concepts. Demonstrates critical thinking, and problem solving, and expresses ideas clearly,