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. As the Lead Director of Market Conduct Exams for the Network Services area, you will have the opportunity to lead and contribute meaningfully to the overall strategic positioning and response to internal/interested parties, such as Government Affairs and affiliated State Lobbyist and PBM alliance associations, as well as key responsibilities and subject matter experts (SME) representing all operational areas within the Retail Pharmacy Network Services division of CVS Caremark. This will be a highly visible role that will require strategic thinking as well as production of the material to be presented. You will be responsible for managing a portfolio of processes and SMEs within the operational areas including but not limited to contract depository retrieval, pharmacy credentialing/recredentialing, pricing/rates, pharmacy audits, post-audit activities and recoveries, and associated state/federal regulations governing all laws pertaining to PBM network comprehensive activities. In this role the Lead Director will be responsible for developing our internal (Government Affairs) and external (State/Federal regulatory entities) specific strategies that align goals and appropriate responses. This individual will have direct interaction with Executive Leadership both internally and externally. As a healthcare leader, direct reports that will be responsible for the management and automation of the processes associated with the information gathering and positioning of responses to Market Conduct Exams. Your primary focus as a Lead Director is to incorporate your proven expertise in Network enrollment documentation/processes, pharmacy audit financial recoveries and other associated activities (i.e., stand-downs from government agencies that pertain to pharmacy audits), in addition to network pricing/contract retrievals in order to set, drive and align organizational focus and strategy regarding responses to in-depth external Exam questions. The successful candidate also should be able to work cross functionally within the Network Services division and Government Affairs, Compliance and Legal departments to expertly coordinate timelines responses, data collection activity, and articulate innovative positioning to drive the desired, relevant results. As you develop subject matter expertise, you will effectively present to regulators evidence of Caremark's compliance with regulations. Develop strategic positioning and response to internal/interested parties, such as Government Affairs and affiliated State Lobbyist and PBM alliance associations, as well as key responsibilities and subject matter experts (SME) representing all operational areas within the Retail Pharmacy Network Services division of CVS Caremark The successful candidate will possess the following skills: + Structured & Logical Thinking: The ability to identify and define business problems and issues, and develop strategic, analytical, and financial frameworks based on current operational knowledge of key department areas to deliver accurate, succinct content results. + Analytical Experience and Rigor: In-depth SME pertinent to the basis of the Market Conduct Exam questions; proven capability conducting and managing quantitative and qualitative analysis to achieve desired inquiry replies. + Operational knowledge / skillset pertinent to the areas within the Market Conduct Exam focus (i.e., Pharmacy audits financial recoveries, required stand-downs, audit turn-around times, appeals, education, enrollment credentialing, contract pricing/retrievals/reconciliation, compliance with regulations) Primary Responsibilities include: - Leading the direct activities for internal and external parties by providing strategic and accurate responses based on real time experience in the disciplines outlined in Market Conduct Exam interrogatories - Accountability and ownership of strategic response development based on in-depth experience regarding specific pharmacy audit, contract, credentialing and financial recovery questions and analysis as required by the market conduct exam activities - Developing and maintaining executive relationships internally and externally - Clearly communicating strategic leveraging opportunities and assessing the associated risks involved - Influencing associated Network Services team members with opportunities to strategize, plan, and develop processes to meet PBM internal/external turn-around times with suitably positioned responses -Understanding, managing, and mitigating applicable state/federal regulations regarding Market Conduct Exams Your success as a Lead Director and Market Conduct Exam strategist will be driven by your ability to articulate, leverage and represent your fellow leaders appropriately in strategy and response development. Your understanding of the healthcare landscape and managed care environment as well as keeping up to date on market trends will enable you to position CVS Caremark effectively as a network partner with Government Affairs and their constituents. The contributions you will make will position you as a key role in CVS Caremark’s long term success in the heavily regulated state and federal pharmacy and healthcare environment. Required Qualifications: + 10+ years of professional leadership experience within highly regulated industry including Pharmacy Benefits Management management, Healthcare, banking, finance, insurance + Minimum of 5 + years of Network Services operational experience in key functional areas specific to Market Conduct Exam questions (managing and working with regulatory exams, market conduct exams, inquiry responses.) + Minimum of 5 years of professional work experience in Pharmacy Benefit Management Industry Preferred Qualifications: + 15+ years of cumulative work experience with the Pharmacy Benefit Management + Prior retail Pharmacy work experience + Demonstrated self-starter knowledge and relatable experience to develop and own content based on past experiences relevant to Exam questions and expectations + Willing to devote effort to improving Caremark business processes to earn the trust of regulators + Knowledge of the Overall Healthcare and Retail Pharmacy Landscape + Strong understanding of Health Plan Payers and associated lines of business-Medicaid, Medicare, Commercial, Exchanges + Passion for Health Care: A history of work in the health care industry and an ongoing desire to make one of the world’s strongest health care companies even stronger. + Team Leadership: Highly developed relationship-building skills to foster effective working relations across key internal areas, such as Government Affairs and Legal + Influencing others: Must possess the ability to structure useful guidance around complex and far reaching strategy decisions to influence strategy to adequately represent other areas within Network Services + Strong communication skills both written and verbal- individual needs to be comfortable presenting to Executives, Subject Matter Experts, Plan Sponsors, Government Affairs, etc. Communicate in an open and honest way that quickly builds trust and respect. + Proficiency with Microsoft Office including PowerPoint and Excel, Word, etc. Education: + Bachelor’s Degree or equivalent work experience required **Pay Range** The typical pay range for this role is: $100,000.00 - $231,540.00 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. 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 people** We 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. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 08/30/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. 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.