Clinical Pharmacist, Compliance

CVS Health

10d

About The Position

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. Position Summary As a Compliance Clinical Pharmacist, you will play a key role in the assessment and execution of compliance regulations. You will leverage your clinical and business expertise to ensure Aetna pharmacy is meeting compliance standards as it relates to Mental Health Parity and state regulations Working closely with cross-functional teams, you will help prioritize regulatory responses, assess NQTL reporting, and assist with regulatory responses.

Requirements

• 5+ years of managed care experience
• 3+ years of compliance, quality and/or regulatory experience.
• Demonstrated excellent and effective verbal and written communication skills.
• Experience managing simultaneous projects with multiple deliverables.
• Attention to detail
• Analytical and problem-solving skills
• Superior critical thinking skills
• Effective time management, organizational and prioritization skills
• Quickly grasp business concepts, objectives, and strategies
• Collaborate effectively and professionally with internal and external partners
• BS in Pharmacy (RPh) or PharmD

Nice To Haves

• Knowledge of fully insured health plans
• Understanding of legal requirements
• Experience with or understanding of Mental Health Parity (MHPAEA)

Responsibilities

• Independently collecting facts and utilizing strong clinical analytical capabilities to provide guidance on Mental Health Parity NQTL analysis in accordance with MHPAEA standards and providing recommendations on formulary updates to ensure compliance.
• Researching and responding to state inquiries from regulatory agencies
• Respond to Mental Health Parity intake requests
• Responding to complex compliance requests for information within area of responsibility
• Monitor pharmacy compliance activities to identify and report trends
• Collaborate with teams to assess reporting to identify and/or develop responses and potential changes to ensure compliance.
• Assist the compliance regulatory team with gathering information and developing responses for Market Conduct Exams.
• Help refine business needs analysis methods to establish requirements and specifications for processes improvement.
• Work closely with actuary team to assess financial impacts due to regulations.

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees