Ld Director, Pharmacy Audit

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.

As the Lead Director of Market Conduct Exams for the Network Services area, you will have the opportunity to lead and contribute meaningfully to the overall strategic positioning and response to internal/interested parties, such as Government Affairs and affiliated State Lobbyist and PBM alliance associations, as well as key responsibilities and subject matter experts (SME) representing all operational areas within the Retail Pharmacy Network Services division of CVS Caremark. This will be a highly visible role that will require strategic thinking as well as production of the material to be presented.

You will be responsible for managing a portfolio of processes and SMEs within the operational areas including but not limited to contract depository retrieval, pharmacy credentialing/recredentialing, pricing/rates, pharmacy audits, post-audit activities and recoveries,  and associated state/federal regulations governing all laws pertaining to PBM network comprehensive activities. In this role the Lead Director will be responsible for developing our internal (Government Affairs) and external (State/Federal regulatory entities) specific strategies that align goals and appropriate responses.  This individual will have direct interaction with Executive Leadership both internally and externally. 

As a healthcare leader, direct reports that will be responsible for the management and automation of the processes associated with the information gathering and positioning of responses to Market Conduct Exams.  Your primary focus as a Lead Director is to incorporate your proven expertise in Network enrollment documentation/processes, pharmacy audit financial recoveries and other associated activities (i.e., stand-downs from government agencies that pertain to pharmacy audits), in addition to network pricing/contract retrievals in order to set, drive and align organizational focus and strategy regarding responses to in-depth external Exam questions. The successful candidate also should be able to work cross functionally within the Network Services division and Government Affairs, Compliance and Legal departments to expertly coordinate timelines responses, data collection activity, and articulate innovative positioning to drive the desired, relevant results. As you develop subject matter expertise, you will effectively present to regulators evidence of Caremark's compliance with regulations.

Develop strategic positioning and response to internal/interested parties, such as Government Affairs and affiliated State Lobbyist and PBM alliance associations, as well as key responsibilities and subject matter experts (SME) representing all operational areas within the Retail Pharmacy Network Services division of CVS Caremark

The successful candidate will possess the following skills:

• Structured & Logical Thinking:  The ability to identify and define business problems and issues, and develop strategic, analytical, and financial frameworks based on current operational knowledge of key department areas to deliver accurate, succinct content results.
• Analytical Experience and Rigor: In-depth SME pertinent to the basis of the Market Conduct Exam questions; proven capability conducting and managing quantitative and qualitative analysis to achieve desired inquiry replies.
• Operational knowledge / skillset pertinent to the areas within the Market Conduct Exam focus (i.e., Pharmacy audits financial recoveries, required stand-downs, audit turn-around times, appeals, education, enrollment credentialing, contract pricing/retrievals/reconciliation, compliance with regulations)

Primary Responsibilities include:
- Leading the direct activities for internal and external parties by providing strategic and accurate responses based on real time experience in the disciplines outlined in Market Conduct Exam interrogatories
- Accountability and ownership of strategic response development based on in-depth experience regarding specific pharmacy audit, contract, credentialing and financial recovery questions and analysis as required by the market conduct exam activities
- Developing and maintaining executive r