Manager Network Audit Government Oversight Adherence

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.

The PBM is currently looking for an energetic individual to join our Government Oversight Accountability Team for our Networks division in a Manager role. This position will act as an important member of the team while managing projects to support strategies, work, and deliverables related to regulatory oversight and exams of PBM network activities that are being performed by regulatory bodies, such as department of insurances.  This role will work cross-functionally and proactively with internal business partners to focus on the most important risks/assessments areas within the organization and develop strategies to gather deliverables and create easy to understand materials to provide meaning insights to external state regulatory agencies and their contracted auditing organizations to demonstrate compliance with applicable regulatory requirements. This role will be responsible for continuously evaluating and recommending operational and process improvements.

As a Manager, PBM Networks, you will be responsible for, but not limited to:

• Lead and manage the daily processes, including timeline development and project management, as it relates to responding to regulatory agencies and their contracted auditing organizations.
• Serve as intermediary between the BCO/auditors and the PBM Networks division business owners.
• Assist in the identification, prioritization, and completion of exam/audit deliverables.
• Improve CVS Health’s PBM Market Conduct Exam communications and process flow standards.
• Prepare preliminary responses to examiner inquiries, criticisms, or findings.
• Creating demonstratives and scenarios to assist auditor(s) with understanding compliance.
• Ensure strong and detailed record-keeping of all deliverables from business partners to examiners.
• Monitor the creation and delivery of any CVS Caremark corrective action plans due to exam findings.
• Perform other duties as assigned.​
• Work on multiple examinations to meet regulatory deadlines

In order to be successful in this role you must exhibit the following:

• Excellent analytical, verbal, and writing communication skills.
• Proven track record in meeting project milestones and deliverables.
• Experience with engaging, motivating, and managing cross-functionally across teams.
• Able to communicate effectively with all levels of management with timely escalation of any high-risk issues to senior management.
• Proven ability to work independently and in collaboration with solid organizational skills.

Required Qualifications

• Minimum of 5+ years professional work experience in Pharmacy Benefit Management Industry or healthcare industry
• Minimum 3 + years’ experience in Network Services operations in key functional areas specific to regulator exam questions
• Must be willing and able to travel to and work from the Scottsdale corporate office as required with minimal notice (e.g. same day and for variable durations).

Preferred Qualifications

• 3+ years of PBM experience
• Prior experience in a relevant auditing role
• Prior experience in strategizing, planning, and developing business compliant audit project plans and corrective action plans.
• Prior project management experience.
• Prior experience working in retail pharmacy
• Prior experience with pharmacy audit/pharmacy pricing appeals/pharmacy contracting/pharmacy complaints
• Master’s degree

Education

• Bachelor’s degree required or equivalent years of experience.  

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$60,300.00 - $132,600.00

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 futu