This position reports to the Lead Director of Quality and Accreditation in Medical Affairs and is responsible for a designated primary area of focus and corresponding enterprise quality and accreditation efforts. The individual is accountable for the accreditation needs of both the business and clients. Leads efforts with business process owners to ensure adherence to accrediting body standards and related CVS Health enterprise policies and procedures. Functions independently as the accreditation SME for internal and external customers; provides clinical and strategic guidance on quality and accreditation initiatives such as quality improvement projects (QIPs); and conducts oversight of accreditation-critical business processes including delegated functions.

Responsibilities include:
1. Manages URAC, NCQA, NABP, ACHC, and/or TJC accreditation audits for CVS Health and provides accreditation audit support for delegated client services. Creates and executes project plans to ensure colleagues, sites, and clients are positioned for successful accreditation reviews. Serves as liaison to internal partners and/or clients and external entities including accrediting agencies.
2. Supports Sales and Account Services, Legal and other impacted business areas as an enterprise accreditation SME. Independently leads accreditation oversight activities per contractual obligations and provides ongoing support as related to accreditation and quality initiatives. Oversees internal business relationships to ensure full compliance to delegated functions critical to client satisfaction and retention.
3. Designs and implements processes for ongoing accreditation compliance. Collaborates with business process owners on internal validation reviews to promptly identify and resolve critical vulnerabilities in accreditation or policy compliance. Provides clinical consultative accreditation support to the enterprise and proactively informs and directs internal business partners so collaborative and fully compliant solutions are identified.
4. Recommends, develops, and drives quality-related processes across the organization to improve patient safety, elevate consumer experience and satisfy accreditation requirements. This involves mentoring,
coordinating of reporting and analysis, and preparing quality improvement projects for internal and external
audiences. Collaborates with teams in Specialty Pharmacy, Mail Service, and/or other applicable clinical business units to identify, develop and support quality improvement efforts.
5. Leads or contributes to department responsibilities such as credentialing, precepting, committee participation, colleague engagement and other Medical Affairs or enterprise-wide initiatives as requested by leadership.

This is a remote role open to candidates in the United States.

Pay Range
The typical pay range for this role is:
Minimum: 97,500
Maximum: 210,000

Please 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

• Registered Pharmacist in good standing with active licensure per state requirements
• 8 to 10 years clinical pharmacy experience, inclusive of experience in the managed care/PBM environment.
• Consistently demonstrate Heart at Work behaviors: join forces, inspire trust, put people first, create simplicity, rise to the challenge, and champion quality and safety

conclusions

• Act strategically and proactively to meet accreditation and business needs; anticipates potential objections and positively influences others when working across multiple business units to collaboratively reach solutions
• Able to engage in and lead conversations with internal and external audiences. Comfortable speaking and presenting in a group environment which may include internal and external senior leaders (e.g., clients, accrediting bodies)
• Strong project management skills: self-motivated with demonstrated ability to manage multiple complex, ongoing projects, coordinate activities with impacted teams, and meet timelines for critical accreditation and/or client deliverables
• Exceptional written and verbal communication skills. Able to respond skillfully and professionally to customers, accreditors or regulatory agencies with full understanding of the required confidentiality protections for patients and the enterprise
• Able to identify and implement strategies to improve work efficiency and quality beyond designated focus area (e.g., simplify, streamline, leverage available technologies)
• Regular and reliable attendance; travel when needed (e.g., accreditation audits, client meetings)

Preferred Qualifications

• Able to work with mathematical concepts for the purpose of assessing and reporting quality performance (including statistical analysis) of clinical programs as well as required accreditation measures
• 2 to 3 years quality, project management or accreditation experience as well as experience with mail service pharmacy
• Demonstrated business proficiency in various other areas including pharmacy operations (Specialty, UM), clinical product offerings, quality improvement processes, and core organizational functions (e.g., Compliance, Privacy, HR, IT/IS, Enterprise Resiliency)
• Strong PC skills: Office 365 with ability to quickly learn new applications as needed

Education
Doctor of Pharmacy (PharmD); B.S. Pharmacy with commensurate experience

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.