Ld Director - Pharmacy Audit

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

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

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.

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