Sr Mgr,Network Mgt

CVS Health

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary: 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 to translate regulatory requirements into operational processes and to initiate system enhancements needed to meet those requirements. The Senior Advisor proactively identifies, assesses, and escalates business risks and impacts to senior Pharmacy Network leadership, as appropriate. 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

Minimum of 7 years of professional experience, including experience in the health care industry.
Experience within a matrix reporting environment.
Bachelor’s degree in Finance, Business, Actuarial Science, Mathematics, or a related 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.
Demonstrated ability to apply strategic thinking, program management, and process reengineering in a cross-functional environment, including oversight of workstreams across Underwriting, Finance, Client Profitability, Implementation, and Data and Systems.
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.

Responsibilities

Serves as the subject matter expert on applicable guidance and regulations.
Leads implementation and continuous improvement initiatives to ensure CVS/Caremark maintains compliance with current and emerging requirements affecting the Pharmacy Network division.
Partners with key functional leaders to translate regulatory requirements into operational processes and to initiate system enhancements needed to meet those requirements.
Proactively identifies, assesses, and escalates business risks and impacts to senior Pharmacy Network leadership, as appropriate.
Serves as a key decision-maker for escalated client issues as part of regulatory issue resolution.