Sr. Manager, Network Services

CVS Health

About The Position

The Pharmacy Network Regulatory Compliance Senior Advisor serves as the subject matter expert on applicable guidance and regulations and leads implementation and continuous improvement initiatives to ensure CVS/Caremark maintains compliance with current and emerging requirements affecting the Pharmacy Network division. This role partners with key functional leaders across Pharmacy Network, PBM Finance, Underwriting, and Client teams to translate regulatory requirements into financially sound, operationally executable processes, including impacts to network economics, reimbursement, pricing/guarantees, and reporting. The Senior Advisor proactively identifies, assesses, and escalates business risks, financial impacts, and P&L implications to senior Pharmacy Network leadership, as appropriate, and supports remediation plans that protect client commitments and enterprise results. The role leverages financial data analytics to quantify and monitor regulatory impacts (e.g., trend, unit cost, network spend, administrative expense), perform variance and root-cause analysis versus forecast/plan, and support KPI reporting for leadership decision-making. This position requires a strong understanding of local, state, and federal regulations and associated end-to-end processes. While the primary focus is on member and pharmacy network impacts, scope may expand to additional business areas as regulations and divisional responsibilities evolve. As part of regulatory issue resolution, the Senior Advisor serves as a key decision-maker for escalated client issues.

Requirements

Demonstrated ability to apply strategic thinking, program management, and process reengineering in a cross-functional PBM environment, including oversight of workstreams spanning Pharmacy Network, Underwriting, PBM Finance (pricing and financial modeling, guarantees, rebate/discount economics, forecasting, client profitability, and P&L drivers), Implementation, and Data and Systems.
Proven ability to use financial data analytics to translate complex requirements into measurable outcomes, including KPI development, performance monitoring, and variance analysis.
Experience analyzing financial and operational data to assess impact to PBM/network P&L, including key drivers (e.g., unit cost, utilization, rebates/discounts, fees, guarantees, and administrative expense) and communicating insights to senior leaders.
Skilled in building and interpreting recurring financial reporting and dashboards (KPIs/OKRs), performing trend and variance analysis versus forecast/plan, and partnering with Finance and Data teams to ensure data quality and consistent metric definitions.
Strong problem-solving, people management, and leadership skills.
Ability to manage, mentor, and motivate a team of highly skilled technical professionals.
Excellent written and verbal communication skills; able to work effectively both independently and in a multidisciplinary team environment.
Proven track record of delivering efficiencies and solutions informed by end-user input that successfully meet business needs.
Demonstrated experience managing complex work processes in a cross-departmental, team-based environment.
Demonstrated success motivating others in a fast-paced, high-pressure environment.
Experience working in a geographically diverse organization and within a matrix reporting environment.
Minimum of 10 years of professional experience, including experience in the health care industry.
Bachelor’s degree in Finance, Business, Actuarial Science, Mathematics, or equivalent professional work experience required

Nice To Haves

Advanced actuarial skills within the health care industry.
Advanced Microsoft Office skills; advanced knowledge of relational databases and data warehouses; and advanced proficiency with SQL, OLAP, and SAS (or similar tools) to support financial analytics, KPI/dashboard reporting, and P&L performance insights.

Responsibilities

Serves as the subject matter expert on applicable guidance and regulations.
Leads implementation and continuous improvement initiatives to ensure compliance with current and emerging requirements affecting the Pharmacy Network division.
Partners with key functional leaders across Pharmacy Network, PBM Finance, Underwriting, and Client teams to translate regulatory requirements into financially sound, operationally executable processes.
Identifies, assesses, and escalates business risks, financial impacts, and P&L implications to senior Pharmacy Network leadership.
Supports remediation plans that protect client commitments and enterprise results.
Leverages financial data analytics to quantify and monitor regulatory impacts.
Performs variance and root-cause analysis versus forecast/plan.
Supports KPI reporting for leadership decision-making.
Serves as a key decision-maker for escalated client issues.