Jobs / United States / CVS Pharmacy INC
Senior Manager MPPS Policy Consultation
CVS Pharmacy INC · 🇺🇸 CT - Work from home
Sponsorship verdict
Sponsorship possible
One solid signal, not two — worth applying, and worth asking about sponsorship early.
- Employer is on a government sponsor recordThe US Department of Labor certified 191 H-1B/E-3 labor condition applications for this employer between Oct 2025 and Jun 2026 (latest Jun 2026) — the step every H-1B hire needs first. USCIS also records 217 H-1B approvals in FY2023. Source: LCA disclosure data (US Department of Labor (OFLC)).
- The posting doesn’t mention sponsorshipSilence isn’t a refusal — ask the recruiter before investing much time.
- No salary bar for this routeH-1B has no fixed salary bar: the employer must pay at least the prevailing wage for the role and area. Cap-subject employers enter a lottery weighted by wage level. Source: https://www.federalregister.gov/documents/2025/12/29/2025-23853/weighted-selection-process-for-registrants-and-petitioners-seeking-to-file-cap-subject-h-1b, rules effective 2026-02-27.
- What CVS Pharmacy INC paid sponsored hires in similar roles3 certified filings for “Manager, Data Engineer” (Data Scientists) in GA: $110k–$162k, median $110k. Most were filed at wage level II (67%) — 2 lottery entries, ≈31% projected selection odds for cap-subject employers. Source: US Department of Labor LCA disclosure data (Oct 2025 – Jun 2026).
- Confirmed live todayWhen a source last listed this job as open.
US H-1B: cap-subject employers enter a lottery weighted by wage level — Level I gets 1 entry, Level IV gets 4 (DHS projected selection odds ≈15% at Level I to ≈61% at Level IV). Universities and non-profit research employers are cap-exempt. The $100,000 fee for new petitions from abroad is currently blocked by a court order (appeal pending).
A verdict summarises public evidence; it is not legal advice and never a guarantee — the employer and the immigration authority decide. Sign in to factor in where you can already work.
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Sponsor Radar — CVS Pharmacy INC
The US Department of Labor certified 191 H-1B/E-3 labor condition applications for this employer between Oct 2025 and Jun 2026 (latest Jun 2026) — the step every H-1B hire needs first. USCIS also records 217 H-1B approvals in FY2023. Source: LCA disclosure data (US Department of Labor (OFLC)).
Past sponsorship or register membership never guarantees sponsorship for this vacancy or for you. Full Sponsor Radar for CVS Pharmacy INC →
About the role
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. May reside anywhere in US Summary: The Senior Manager MPPS Policy Consultation is responsible for the identification, development, and execution of clinical and payment policies, ensuring alignment with evidence-based guidelines, regulatory requirements, and enterprise affordability goals. This role serves as a subject matter expert (SME) bridging clinical policy, coding, and claims adjudication by translating clinical and payment policy intent into clear business requirements that drive accurate configuration and enforcement within claims processing platforms. The position partners across Medical Policy, Medical Coding, Compliance, and vendor teams to ensure policy is operationalized consistently across end-to-end claims workflows (intake, edits, adjudication, denials, and appeals). Clinical and Payment Policy Development · Lead identification of new and emerging clinical and policy opportunities, including: · Medical correct coding vulnerabilities · Payment integrity risks · Interpret clinical evidence, regulatory guidance, and industry best practices to: · Develop or revise clinical or payment medical policies · Define coverage criteria, limitations, and exclusions · Ensure policies are clinically sound, evidence-based, and aligned with CMS/state guidance Payment Policy & Claims Editing Strategy · Define and drive payment policy strategies to ensure accurate claim adjudication and cost containment · Translate policy intent into: · Claims editing logic · Correct coding requirements (DX, CPT/HCPCS, modifiers, frequency rules) · Adjudication outcomes (deny, pend, allow, PA requirement) · Partner with payment integrity and vendor teams (e.g., editing engines) to implement scalable solutions Business Requirements Development (BRDs) · Own development of detailed Business Requirements Documents (BRDs) to support policy implementation, including: · Policy intent and business objectives · Coding and clinical logic · Claims system behavior across adjudication points · Configuration and testing requirements · Ensure requirements are: · Clear, actionable, and testable · Aligned with claims platform capabilities (e.g., ACAS, QNXT, HRP) · Act as the primary liaison between clinical SMEs and technical/configuration teams Claims Adjudication & Operational Integration · Partner with claims operations to ensure policy is correctly implemented across: · Front-end edits · Pre-payment edits · Post-adjudication processes · Validate that behavioral health policies are correctly translated into system logic and medical coding rules · Support testing, defect resolution, and go-live readiness Quality Assurance, Compliance & Audit Readiness · Perform policy QA and validation to ensure: · Alignment between clinical intent and system execution · Compliance with federal/state regulations and payer requirements · Support audits and remediation efforts by: · Identifying gaps in policy, medical coding, or configuration · Driving corrective actions Cross-Functional Leadership & Governance · Serve as Clinical and Payment policy SME across: · Medical Policy governance forums · Payment policy and vendor edit w