Manager, Professional Practice Forgery

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.

The Manager, Pharmacy Professional Practice will focus on prescription forgery investigations, lead the continued refinement and development of forgery detection algorithms, lead the analysis of prescription forgery data, and direct the development, design, and implementation of pilot programs and mini tests aimed at combating controlled substance and non-controlled substance prescription forgery, with a primary focus on non-controlled medications.

The Manager Professional Practices Forgery Program, will lead a multi-year strategic plan that includes ongoing monitoring and adaptation to new threats for both controlled and non-controlled prescriptions. This will include the implementation of new programs, IT solutions, and integration of advanced analytics and data into CVS Health’s fraud and forgery surveillance models and will join forces with Specialty, Mail, Coram, and Omnicare when applicable. 

This role requires a unique skill set in which the individual must be highly knowledgeable of prescription dispensing terminology, must have experience with SQL and data analytics, and must be familiar with both regulatory requirements for state and federal law in regard to fraudulent or forged prescriptions.

The ideal candidate will collect, measure, and interpret data from both internal and external sources, identify actionable areas, and focus on interventions to improve forgery detection and prevention. This colleague will drive the translation of key insights from data which will inform future business decisions on prescription forgery and then join forces with enterprise forgery team members responsible for designing and executing the strategy within their specific business units and then will lead components of impactful and complicated IT enhancement projects aimed at identifying and combating prescription fraud and forgery of both controlled and non-controlled substances.  The candidate will need the ability to define and execute creative solutions to complex and undefined problems.

The Manager, Professional Practice Forgery will have an established history of delivering results in challenging environments/circumstances. This role requires the individual to routinely interact with members of state and federal regulatory agencies, payors, external vendors, including consulting partners, business compliance, pharmacy operations, legal, and asset protection to support adherence to federal and state laws, regulatory standards, and CVS policies associated with prescription forgery. The colleague will need to form and maintain strong relationships and constantly collaborate with Specialty, Mail, Coram, and Omnicare forgery team members. The individual will clearly communicate ideas, have a strong presentation presence, and experience building professional materials.

Primary Job Duties & Responsibilities:

• Process, execute, manage, and maintain all prescription forgery protocol day-to-day activities, tasks, responsibilities, and requirements for both controlled substances and non-controlled substances, with a focus on non-controlled substances.

• Update prescription forgery training and field communications based on emerging risks.

• Collaborate with internal teams and stakeholders to resolve all prescription forgery related inquiries.

• Lead the evolution of the enterprise Prescription Forgery program and develop business solutions to address changes.

• Monitor the effectiveness of CVS Health’s current prescription forgery processes.

• Lead actions and development of programs to support pharmacist and technician adherence to federal and state requirements and CVS prescription forgery policy across more than 9,000 retail locations, both directly and indirectly through field leaders – assist with Specialty, Mail, Coram, and Omnicare forgery teams/departments.

• Communicate informative prescription forgery updates and trends to senior leaders and legal partners.

• Form a strong bond and connect