Executive Director, Medicare Regulatory Affairs

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Position Summary

Caremark is the nation's leading pharmacy benefit manager (PBM). We work to ensure the path to better health is affordable, easy to access, and simple to follow, for our health plan sponsors and employer group clients and their 103 million plan members.

Caremark is recruiting an Executive Director for Medicare Regulatory Affairs to play a crucial role in shaping the Medicare regulatory landscape within the Government Services Division and Pharmacy Benefit Management (PBM) business. Reporting directly to the VP of Regulatory Affairs, you will spearhead the strategic development and oversight of Medicare regulatory initiatives for the PBM. The responsibilities will encompass driving regulatory strategies to optimize client value; interpreting legislative action and agency guidance, then advising and supporting business implementation of relevant processes; and ensuring effective plan sponsor and stakeholder communication to support the Managed Medicare business segment. Key areas of focus include Medicare Part D, Medicare Part B, Medicare Managed Care (MMP demonstrations), Employer Group Waiver Plans (EGWPs), and Retiree Drug Subsidy (RDS).

You'll make an impact by:

• Accountability for all Medicare regulatory deliverables associated with the release of proposed, pending, and final regulations – including the drafting of comments to CMS on proposed regulations and/or RFPs as they relate to the PBM.

• Leading and directing a team of Medicare regulatory subject matter experts to deliver solutions that balance the demands of a highly regulated Medicare environment including health plan contractual obligations, enterprise priorities, and customer expectations.

• Designing and managing effectiveness of Medicare regulatory activities, including intuitiveness, timeliness, accuracy, quality, and business partner and health plan satisfaction.

• Developing and managing the strategic Medicare Regulatory agenda for the PBM and the health plan and plan sponsors we serve.  This will include careful and deliberate analysis of pending legislation, its impact on CVS, our clients, and the industry overall.  You will be expected to identify both threats and opportunities, mitigate risks to all key stakeholders and identification of resources to help ensure outcomes meet regulatory expectations.

• Managing and influencing outcomes associated with large, complex, multi-department partners at all levels of the company.  You will have the opportunity to lead cross-functional initiatives within Regulatory Affairs, Government Services, and other business areas as well as partner with others in the industry to drive solutions to regulatory opportunities and challenges identified by our stakeholders.

• Responsibility for developing and managing the goals and objectives of the department along with team design and effectiveness.

• Developing and managing a yearly account management strategy with internal and external key constituents designed to help drive viable outcomes for the PBM and the customers we serve. 

• Representing the PBM to industry partners (PCMA, NCPDP, AHIP, etc.) and work with those partners to help forward the CVS Health PBM agenda. 

• Supporting CVS Health in attracting, retaining, and engaging a diverse and inclusive consumer-centric workforce that delivers on our purpose and reflects the communities in which we work, live, and serve.

Required Qualifications

The candidate will have a strong work ethic, be a self-starter, and be able to be highly productive in a dynamic, collaborative environment. This position offers broad exposure to all aspects of the company’s business, as well as significant interaction with all the business leaders. The candidate will be expected to have the following key attributes:

• 10+ years of demonstrated leadership experience, including the design and implementation of strategy for direct and indirect colleague oversight and development.

• 10+ years of experience working in PBM Government Services, Health Plan, Regulatory agencies,