Lead Director - Medicaid Pharmacy (Finance)

Job DescriptionThis is a new resource dedicated to Medicaid Pharmacy Expense Review, supporting the Medicaid Business Unit within Aetna. The Medicaid Pharmacy Director is a new leadership position in a very fast paced and dynamic environment with a high performing team and there are high expectations. This leader is responsible for evaluating internal and external pharmacy cost trend and trend drivers and works collaboratively across the Finance, Actuarial, Medical Policy, Clinical, Network, Operations and Product to determine the financial impact resulting from changes in CVS Health and Aetna's medical cost management strategy, pricing position and earnings generation. This new position will combine focused analytical research, complex financial modeling, and business decision support related to pharmacy actions and medical cost strategy with decision making on pricing and long term, sustainable earnings growth. This position will interface not only within Healthcare Benefits, but across CVS Health through collaboration with the Retail and Pharmacy Service Segments to cultivate a holistic dialogue and strategy in the collective pharmacy franchise of the Enterprise. This leadership position is required to interface with senior leadership, describing detailed and intricate data in a way that can be digested by VPs and above. The role combines a dense subject matter expertise with advanced communication skills. In addition, the leader in this new position must be able to describe potential business actions that should occur and work across the diverse stakeholder groups and functions (listed above) to ensure those actions, and new opportunities, are implemented and monitored with high precision and success. This position is required to fulfill the Enterprise goals of effective medical cost management and medical cost leadership A primary goal of this team is to provide timely, accurate, actionable data and analysis for utilization and unit cost management in support of the organization's strategic financial strategy. Align with senior Medical Economics leaders to set organizational strategy. Develops and presents actionable recommendations to management based on analysis. Participates in research-related activities including industry best practices and experience studies. This leader will participate and lead on work groups/ forums representing CVS Health to external constituents. Anticipate and recognize matters that materially affect financial results and drive sound, unbiased actions on these matters. This leader role will expand to have oversight of staff, and will grow to be responsible for hiring, training, developing, mobilizing, organizing and firing staff This leader must foster talent development, decision-making and leadership to promote a high performance environment within a broader high performing MEU organization (and eventually targeting that leadership to a team of 5 individual contributors, including identifying staffing needs and is responsible for management activities related to staffing, talent management, training and development) Manages and directs a block of business balancing membership, revenue growth and profitability targets including complex/high profile cases and/or markets. Collaborates with other constituents on product and pricing strategies. Applies rigorous financial and value analysis to manage and enhance profitability and membership. This leader designs, ideates and implements policy to protect the Organization's financial integrity This leader must proactively and independently identify critical medical cost issues and designs and recommends solutions to business problems to staff, senior Executive leadership, and business partners Support CVS Health's financial integrity with sound reserving and risk management practices as well as product designs that meet customer needs and pricing that produces returns to shareholders commensurate with the risks undertaken. Actuarial is responsible for anticipating and recognizing matters that materially affect financial integrity and making sound, unbiased reports on these issues. Accountable for successfully protecting CVS Health's financial integrity in support of stated mission. Leads projects in support of strategic and cross-enterprise operating plan goals. Anticipate and recognize matters that materially affect financial results and make sound, unbiased reports on these matters. Participate on work groups/forums representing CVS Health to external constituents. Directs the Actuarial staff and manages the business of the Actuaries. Ability to issue an Actuarial Communication as defined in the Actuarial Standard of Practice. Conveys a clear sense of CVS Health's core values and business plan. Determines key factors affecting the financial plan and proactively influences those factors to align with CHS Health's goals based on knowledge of the economy, industry trends and market place conditions. Participates in the development of market pricing strategies to optimize competitiveness and earnings. Influences and institutes change in Actuarial policy or premium rates to maximize profitability while managing risk. Leads the actuarial team to inspire and sustain the competitive advantage. Partners with appropriate operational areas to proactively ensure sold products can be implemented and administered based on CVS Health's quality standards and guidelines. Develops staffing plans, builds and influences high performing diverse workforce teams. Manages resources to assure high performance metrics are achieved. Works cross-functionally with other business segments on product and pricing strategies. Negotiate and influence sound corporate decisions by adhering to established risk management principles. Ensures regulatory compliance. Contributes to company success of increasing business through maintenance of market alliances and relationships across market segments.Pay RangeThe typical pay range for this role is:Minimum: 100,000Maximum: 221,000Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required Qualifications10 years' experience, equivalent experience can include education with FSA, which is preferred but not required. Excellent analytical and problem solving skills Strong organizational, management and leadership skills Excellent written and verbal communication and presentation skills. Proven leadership skills and strong cross-functional relationships with sales force and other internal organizations. Experience in anticipating customer needs and requirements as well as facilitating and negotiating using tact and diplomacy. Demonstrated success in communicating effectively with internal and external constituents. Proven ability to negotiate internal and external cross-functional business issues.Preferred QualificationsExcellent analytical and problem solving skills. Strong organizational, management and leadership skills Excellent written and verbal communication and presentation skills. Proven leadership skills and strong cross-functional relationships with sales force and other internal organizations. Experience in anticipating customer needs and requirements as well as facilitating and negotiating using tact and diplomacy. Demonstrated success in communicating effectively with internal and external constituents. Proven ability to negotiate internal and external cross-functional business issues.EducationBachelor Degree - REQUIRED (Actuarial Science, Mathematics, Statistics, or other related field), Other License(s): Fellow of the Society of Actuaries (FSA) preferred, MAAA preferred,Business OverviewBring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Created: 2024-11-02