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Position Summary
Join our dynamic Pharmacy Audit group as the Senior Manager of Pharmacy Post Audit, where you will lead a dedicated team that supports various groups within the company, including pharmacy performance, network account management, adjustment services, and more. This role is pivotal in ensuring compliance with state pharmacy audit laws and involves leading a team that reviews onsite and investigational audits against applicable State Audit Legislation nationwide. Your team will determine if audits were performed within the requirements dictated by State Law, address pharmacy appeals to audits, and report results both internally and to the audited pharmacies. Additionally, your team will oversee all pharmacy audit correspondence, review appeal documentation submitted by pharmacies, and prepare internal post-audit reports.
As the Senior Manager, you will oversee processes to track, monitor, and report Caremark’s audit activities and findings to our network pharmacies and senior leaders. You will work closely with chain and PSAO contacts to develop and maintain strong working relationships and collaboration as it pertains to pharmacy performance and pharmacy audits.
In this role, you will be responsible for actively managing workload and dynamically redeploying human resources to meet fluctuations in demand. You will review executed pharmacy audit legislation and oversee custom audit processes as needed to ensure compliance. Additionally, you will consult with other areas in the department and act as a subject matter expert in areas related to Pharmacy Audit, pharmacy audit legislation, post-audit procedures, and more. You will also be the key contact for all Chain and PSAO headquarters regarding onsite and investigational audit activities.
- Lead and supervise a team of employees, providing continuous feedback and support.
Plan, organize, and execute goals, ensuring alignment with department objectives.
Monitor employee performance and productivity through KPIs and various reports.
Generate and manage department reports and address inquiries from various stakeholders.
Create and maintain Onsite/Post Audit’s Policies and Procedures and summary templates.
Manage documentation retention and ensure CMS compliance.
Oversee and monitorstate pharmacy audit law legislation, partnering with the Legal department to understand and update state audit law compliance tracking.
Oversee departmental claim adjustments and finances, ensuring accuracy and compliance with policies and regulations.
Collaborate with others to innovate, resolve difficulties, and achieve common goals.
Act as Business Product Manager for developing an external-facing client product.
You will be successful in this role with the following experience:
A background in pharmacy and/or audit.
In-depth knowledge of pharmacy audit and State Pharmacy Audit Laws, and experience working with attorneys interpreting legislation
High proficiency in working with large data sets and understanding operational SOX controls.
The ability to work in a fast-paced, dynamic environment with tight deadlines.
Excellent communication and collaboration skills.
Experience in setting up new processes and executing against them.
The ability to communicate complex processes in an easy-to-understand way.
Experience extracting, manipulating, and analyzing data to draw conclusions or troubleshoot issues.The ability to appropriately prioritize, ensuring focus on the highest impact activities.
This position will be located out of our offices in Scottsdale, AZ.
Required Qualifications
Preferred Qualifications
10+ years of PBM experience
2+ years of pharmacy experience
5+ years of audit experience
Understanding of SQL databases and querying skills
Familiarity with state and federalpharmacy audit legislation
Strong motivational and team leadership skills
Deep understanding of audit operations
Familiarity with contracting
Project management experience
Education
Pay Range
The typical pay range for this role is:
$75,400.00 - $165,954.00
This 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. This position also includes an award target in the company’s equity award program.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit Benefits | CVS Health
We anticipate the application window for this opening will close on: 06/30/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
