We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary
The Senior Manager, Project Management – Pharmacy Compliance leads strategic compliance initiatives across Aetna Pharmacy Health Plan programs, ensuring adherence to evolving state and federal regulations. As a subject matter expert on legislation, regulatory requirements, and compliance initiatives impacting pharmacy programs and prescription drug products administered through both the pharmacy and medical, this role provides strategic guidance, regulatory interpretation, and leadership across implementation and regulatory readiness activities. The Senior Manager partners with stakeholders to assess impacts, mitigate compliance risks, and support regulatory initiatives, including oversight of prior authorization and utilization management activities for prescription drug products processed through the medical benefit. This leader plays a key role in shaping compliance strategy and mentoring project managers to drive effective execution and delivery.
Key Responsibilities
Lead strategic compliance initiatives and complex cross-functional projects impacting pharmacy programs and prescription drug products administered through the pharmacy and medical.
Serve as a subject matter expert on legislation, regulatory requirements, and compliance initiatives, providing regulatory interpretation, impact assessments, and implementation guidance.
Oversee compliance activities and operational processes, including prior authorization and utilization management requirements for prescription drug products processed through the medical benefit.
Partner with Pharmacy, Medical Pharmacy, PBM, Legal, Clinical, Operations, and business stakeholders to implement regulatory changes, mitigate compliance risks, and ensure business readiness.
Support regulatory inquiries, audits, reporting, monitoring activities, and compliance governance efforts.
Drive regulatory readiness, process improvement, and operational effectiveness across compliance programs.
Mentor and develop project managers while helping shape compliance strategy and execution across the organization.
Required Qualifications
7+ years of experience in pharmacy benefit management, pharmacy operations, managed healthcare, compliance, regulatory affairs, or related healthcare functions.
5+ years of project management experience, including leadership of complex compliance or regulatory initiatives.
Strong knowledge of healthcare regulatory environments and legislative review processes.
Proven ability to lead cross-functional teams and manage multiple high-impact initiatives simultaneously.
Strong analytical, problem-solving, and decision-making skills.
Exceptional communication, collaboration, and stakeholder engagement skills.
Proficiency in Microsoft Office Suite, including Excel, Outlook, PowerPoint, SharePoint, and Teams
** This role can be located anywhere in the Mainland United States
Preferred Qualifications
Experience interpreting and implementing healthcare legislation and regulatory requirements.
Knowledge of pharmacy benefit programs and prescription drug products administered through the medical benefit.
Experience supporting compliance programs, regulatory implementation activities, prior authorization, utilization management, or related operational processes.
Demonstrated ability to influence stakeholders and drive complex cross-functional initiatives in a highly matrixed environment.
Experience mentoring, coaching, or leading project managers and project teams.
Project Management Professional or other relevant project management certification.
Education
Bachelor's degree or equivalent experience may be considered.
Pay Range
The typical pay range for this role is:
$67,900.00 - $182,549.00
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. This position also includes an award target in the company’s equity award program.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- 7+ years of experience in pharmacy benefit management, pharmacy operations, managed healthcare, compliance, regulatory affairs, or related healthcare functions
- 5+ years of project management experience, including leadership of complex compliance or regulatory initiatives
- Strong knowledge of healthcare regulatory environments and legislative review processes
- Proven ability to lead cross-functional teams and manage multiple high-impact initiatives simultaneously
- Strong analytical, problem-solving, and decision-making skills
- Exceptional communication, collaboration, and stakeholder engagement skills
- Proficiency in Microsoft Office Suite, including Excel, Outlook, PowerPoint, SharePoint, and Teams
- Bachelor's degree or equivalent experience may be considered
- Experience interpreting and implementing healthcare legislation and regulatory requirements
- Knowledge of pharmacy benefit programs and prescription drug products administered through the medical benefit
- Experience supporting compliance programs, regulatory implementation activities, prior authorization, utilization management, or related operational processes
- Demonstrated ability to influence stakeholders and drive complex cross-functional initiatives in a matrixed environment
- Experience mentoring, coaching, or leading project managers and project teams
- Project Management Professional or other relevant project management certification
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
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