CVS Health-posted 2 months ago
$99,420 - $214,137/Yr
Full-time • Senior
Remote • Work at Home, KY
5,001-10,000 employees
Ambulatory Health Care Services

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. This is a fully remote, work from home role. The ideal candidate will reside in the state of Kentucky. The Pharmacy Director for Aetna Better Health of Kentucky will be responsible for all clinical, financial, operational and compliance activities related to the prescription drug benefit for the Plan. The Pharmacy Director is an integral member of the health plan executive leadership team (CEO, COO, CMO, CFO, Legal, and Actuarial) providing leadership, analysis, and guidance to the health plan and external partners for the state Managed Medicaid pharmacy benefit. The Pharmacy Director reports to the Senior Lead Pharmacy Director and holds an organizational chart dotted line directly to each respective Health Plan Line of Business CEO or CMO. The role of the Pharmacy Director is to oversee and manage all financial and operational aspects of pharmacy and prescription drug services within the Kentucky Medicaid health plan and to execute the Pharmacy Benefit in accordance with all statutes, regulations, and contractual requirements. This position plays a critical role in ensuring the safe, effective, and efficient use of medications for plan members.

  • Develop and implement strategic plans for pharmacy services that align with the organization's goals and objectives.
  • Manage the pharmacy benefit program offered by the health plan, including benefit set-up, claims processing, and formulary management.
  • Ensure compliance with state and federal statutes and regulations pertaining to pharmacy practice laws and Managed Medicaid/PBM regulations.
  • Collaborate with pharmacy network providers and manage relationships with pharmacy benefit managers (PBMs) and other vendors.
  • Oversee the development and implementation of clinical pharmacy programs aimed at improving patient outcomes and medication safety.
  • Establish and maintain quality assurance programs to ensure the safe and effective use of medications.
  • Manage the pharmacy budget and work closely with the Chief Financial Officer (CFO) and Actuary team.
  • Active Kentucky Pharmacist License
  • 5 years' experience in managed care pharmacy
  • 5 years' experience in Medicaid Managed Care pharmacy or residency in managed care pharmacy
  • M.B.A from accredited university
  • Affordable medical plan options
  • 401(k) plan (including matching company contributions)
  • Employee stock purchase plan
  • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
  • 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
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