Clinical Pharmacist, Compliance
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.
What will you do:
• 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.
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• Work closely with actuary team to assess financial impacts due to regulations.The ideal candidate should possess the following skills:• 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 partnersRequired Qualifications
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.Preferred Qualifications
Knowledge of fully insured health plans
Understanding of legal requirements
Experience with or understanding of Mental Health Parity (MHPAEA)Education
BS in Pharmacy (RPh) or PharmD Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:$106,200.00 - $225,000.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
- 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.
Perks and Benefits
Health and Wellness
- Health Insurance
- Dental Insurance
- Vision Insurance
- Life Insurance
- HSA
- HSA With Employer Contribution
- Pet Insurance
- Mental Health Benefits
Parental Benefits
- Fertility Benefits
- Adoption Assistance Program
- Family Support Resources
Work Flexibility
- Flexible Work Hours
- Remote Work Opportunities
- Hybrid Work Opportunities
Office Life and Perks
Vacation and Time Off
- Paid Vacation
- Paid Holidays
- Personal/Sick Days
Financial and Retirement
- 401(K) With Company Matching
Professional Development
- Tuition Reimbursement
Diversity and Inclusion
- Employee Resource Groups (ERG)
- Diversity, Equity, and Inclusion Program