Lead Director Actuarial - Medicaid Pharmacy
Company: CVS Pharmacy
Location: Hartford
Posted on: January 25, 2023
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Job Description:
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Director Actuarial - Medicaid PharmacyJob ID: 2258958BR
Category:Actuarial
Remote: Fully RemoteJob Description
This 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 Range
The typical pay range for this role is:
Minimum: 100,000
Maximum: 227,000Please 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
Qualifications
10 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 Qualifications
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.Education
Bachelor Degree - REQUIRED (Actuarial Science, Mathematics,
Statistics, or other related field), Other License(s): Fellow of
the Society of Actuaries (FSA) preferred, MAAA preferred,Business
Overview
Bring 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.
Apply
Keywords: CVS Pharmacy, Hartford , Lead Director Actuarial - Medicaid Pharmacy, Executive , Hartford, Connecticut
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