Associate Director overseeing compliance and risk management at Clinica Sierra Vista. Leading strategic initiatives for regulatory compliance and risk reduction in healthcare deliveries.
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Hybrid Senior Clinical Pharmacist, Medical Affairs – Clinical Innovation and Regulatory Strategy
Posted 2 months ago
About the role
- Senior Clinical Pharmacist in Medical Affairs developing clinical programs and regulatory strategies for CVS Health's diverse healthcare solutions. Ensuring compliance and driving performance through analytics and cross-functional collaboration.
Responsibilities
- Identify opportunities and best practices in the development and maintenance of programs supported by Medical Affairs
- Drive the regulatory strategy of UM programs and support regulatory compliance activities for Medical Affairs
- Provide oversight and clinical review of projects ensuring consistency with best practices and ethical standards
- Facilitate cross-functional work teams to ensure accurate representation of clinical content and regulatory statutes
- Lead the implementation of key priorities in CASA to improve performance and efficiencies
- Manage the maintenance and external requests of Medical Affairs UM Policies and Procedures
- Support Clinical Program Review Committee meetings
- Perform as Medical Affairs Ambassador across organization by supporting all Heartbeat page maintenance throughout Medical Affairs
- Work with the Lead Director of Clinical information, Analytics and Regulatory Compliance to ensure equitable application of UM across medical/surgical and behavioral health therapies
- Facilitate initiatives to ensure clinical programs (formulary, UM criteria) comply with MHPAEA, CMS, and DOI regulations
- Lead audit readiness and response activities for PBM market conduct exams, Mental Health Parity, CMS audits, and internal regulatory reviews
- Drive the completion and compliance of the NQTL Library creation and annual review activities
- Support analytics activities and collaborations to measure and communicate the value of clinical programs
- Analyze large datasets to identify trends and identify opportunities for clinical program optimization and improvement
- Assist in the development of business cases and value models to forecast and track program performance and benefits realization
- Represent Medical Affairs in cross-functional forums, key initiatives, projects and planning sessions.
Requirements
- PharmD/RPh or equivalent clinical pharmacy degree
- Active pharmacist license in good standing
- 7+ years of experience in regulatory pharmacy, managed care, or PBM operations
- 3+ years of professional experience in reviewing and evaluating data and trends
- Strong understanding of MHPAEA, CMS regulations, and audit processes
- Demonstrated leadership, organizational and planning skills
- Excellent communication and stakeholder engagement skills
- Ability to work in an agile environment to support the needs of Medical Affairs as they arise
- Comprehensive understanding of managed care, PBM services and customers.
Benefits
- Affordable medical plan options
- 401(k) plan (including matching company contributions)
- 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.
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