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.

The Manager, Pharmacy Professional Practice will focus on prescription forgery investigations, lead the continued refinement and development of forgery detection algorithms, lead the analysis of prescription forgery data, and direct the development, design, and implementation of pilot programs and mini tests aimed at combating controlled substance and non-controlled substance prescription forgery, with a primary focus on non-controlled medications.

The Manager Professional Practices Forgery Program, will lead a multi-year strategic plan that includes ongoing monitoring and adaptation to new threats for both controlled and non-controlled prescriptions. This will include the implementation of new programs, IT solutions, and integration of advanced analytics and data into CVS Health’s fraud and forgery surveillance models and will join forces with Specialty, Mail, Coram, and Omnicare when applicable. 

This role requires a unique skill set in which the individual must be highly knowledgeable of prescription dispensing terminology, must have experience with SQL and data analytics, and must be familiar with both regulatory requirements for state and federal law in regard to fraudulent or forged prescriptions.

The ideal candidate will collect, measure, and interpret data from both internal and external sources, identify actionable areas, and focus on interventions to improve forgery detection and prevention. This colleague will drive the translation of key insights from data which will inform future business decisions on prescription forgery and then join forces with enterprise forgery team members responsible for designing and executing the strategy within their specific business units and then will lead components of impactful and complicated IT enhancement projects aimed at identifying and combating prescription fraud and forgery of both controlled and non-controlled substances.  The candidate will need the ability to define and execute creative solutions to complex and undefined problems.

The Manager, Professional Practice Forgery will have an established history of delivering results in challenging environments/circumstances. This role requires the individual to routinely interact with members of state and federal regulatory agencies, payors, external vendors, including consulting partners, business compliance, pharmacy operations, legal, and asset protection to support adherence to federal and state laws, regulatory standards, and CVS policies associated with prescription forgery. The colleague will need to form and maintain strong relationships and constantly collaborate with Specialty, Mail, Coram, and Omnicare forgery team members. The individual will clearly communicate ideas, have a strong presentation presence, and experience building professional materials.

Primary Job Duties & Responsibilities:

• Process, execute, manage, and maintain all prescription forgery protocol day-to-day activities, tasks, responsibilities, and requirements for both controlled substances and non-controlled substances, with a focus on non-controlled substances.

• Update prescription forgery training and field communications based on emerging risks.

• Collaborate with internal teams and stakeholders to resolve all prescription forgery related inquiries.

• Lead the evolution of the enterprise Prescription Forgery program and develop business solutions to address changes.

• Monitor the effectiveness of CVS Health’s current prescription forgery processes.

• Lead actions and development of programs to support pharmacist and technician adherence to federal and state requirements and CVS prescription forgery policy across more than 9,000 retail locations, both directly and indirectly through field leaders – assist with Specialty, Mail, Coram, and Omnicare forgery teams/departments.

• Communicate informative prescription forgery updates and trends to senior leaders and legal partners.

• Form a strong bond and connection with and collaborate daily with Specialty, Mail, Coram, and Omnicare forgery team members.

• Lead prescription forgery reporting activities (field reporting and internal outputs)

• Lead the identification of prescription forgery trends and emerging issues leveraging data and advanced analytics.

• Drive the translation of key success insights from testing and learnings which will inform future business decisions in the enterprise prescription forgery space, for both controlled and non-controlled substances

• Send prescription forgery details to regulators ad hoc or as required based upon state specific requirements.

• Manage internal and external relationships to support compliance to state and federal requirements regarding prescription forgeries

• Collaborate cross functionally to develop and implement strategic objectives by maximizing the use of new technology and processes within the prescription forgery space.

• Lead continuous improvement processes to sharpen and drive forgery detection and prevention efficiencies.

• Drive the ideation of solutions/vision, requirements, test case creation, testing/UAT, deployment of new and complex, prescription forgery IT projects, all aimed at innovating the enterprises’ controlled substance and non-controlled substance prescription forgery detection and prevention program 

• Lead prescription forgery investigations to include evaluating and investigating circumstances, identifying root cause concerns if applicable, and creating documents based on case specifications

Essential Qualifications and Functions: 

• Experience with SQL: Must be proficient with SQL to store and manage data efficiently, relate various databases, and build database structures.

• Regulatory Knowledge with state and federal laws relating to controlled substances and prescription forgeries.

• Structured & Logical Thinking: Strong understanding and experience in data analytic. The ability to identify and define business problems and issues, and develop strategic, and analytical frameworks to conduct analysis and/or measure success. Must be able to operate at this level when the problem is undefined and ambiguous. Self-directed, works with autonomy and highly organized.

• Analytical Rigor: Proven capability managing quantitative analysis. Highest level of diligence

• Intellectual Curiosity and Tenacity: Ability to explore both internal and external resources to identify new patterns and learn independently to understand and solve complex problems. Identify and tackle intrinsically difficult problems.

• Joining Forces excels at building relationships and influencing internal and external stakeholders to drive cross-company consensus - Form a strong bond and connection with and collaborate daily with Specialty, Mail, Coram, and Omnicare forgery team members.

Required Qualifications

• Minimum of 5 years prior data analytics experience or equivalent experience

• SQL experience

• Proficient in Excel

• Knowledge and understanding of prescription dispensing terminology.

• Strong organizational & time management skills

• Experience in data analysis with ability to present and support clear and concise findings

• Experience identifying process improvement opportunities & proposed solutions supported by data analysis

• Ability to work independently

Preferred Qualifications

• Tableau or excel based dashboard building.

• Pharmacy Experience

Education

Bachelors degree, or equivalent experience

Pay Range

The typical pay range for this role is:

$66,330.00 - $145,860.00

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. 
 
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: 12/01/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.