Pharmacy Audit Pbm Jobs (NOW HIRING)

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Position Summary:

As a Pharmacy Benefit Manager (PBM) Corporate Compliance Lead Director, you will serve as a key compliance leader responsible for overseeing regulatory adherence and governance across Caremark's PBM business. In this highly visible role, you will help ensure alignment with evolving state and federal PBM requirements while partnering closely with PBM Operations, Legal, Enterprise Compliance, and other cross-functional business partners.

As a strategic member of the Compliance leadership team, you will guide the integration of compliance obligations into the organization's operational, contractual, data, technology, and client-facing processes. You will provide leadership and oversight to promote continuous regulatory readiness, strengthen risk management practices, establish and maintain effective compliance controls, validate compliance through evidence-based reviews, and foster a proactive culture of compliance within a complex and rapidly evolving regulatory environment.

Success in this role requires a collaborative and influential leader who can build strong partnerships, develop high-performing teams, provide trusted guidance to stakeholders, drive alignment across diverse teams, and uphold the highest standards of regulatory integrity and operational excellence.

Key Responsibilities:

• Lead regulatory compliance initiatives for Caremark's PBM business, including assessing new federal and state requirements; partnering with Legal to determine regulatory applicability and business impact; and driving implementation of compliance requirements across business operations, systems and controls.

• Partner with Legal and cross-functional stakeholders to ensure compliance is embedded across business operations, processes, systems, and governance frameworks.

• Drive implementation of regulatory requirements and compliance initiatives through completion, validating effectiveness through evidence of compliance and ensuring sustainable operational controls are established and maintained.

• Oversee PBM-related compliance investigations, including issue assessments, root cause analysis, reporting, and executive updates, while ensuring effective corrective actions are implemented and sustained.

• Represent Compliance on enterprise governance committees and key business initiatives.

• Provide strategic compliance leadership, guidance to business partners, fostering a culture of compliance, regulatory accountability, and operational excellence.

• Lead, mentor, and develop a team of compliance professionals and people leaders through coaching, performance management, succession planning, and talent development.

Required Qualifications:

• 10+ years of combined experience in Compliance, Regulatory Affairs, Risk Management, Audit, Project Management or similar oversight disciplines

• Strong background in leading major projects and mentoring project leaders

• Ability to travel up to 10%-15% (including by plane)

Preferred Qualifications:

• Deep expertise in PBM regulatory and operational domains, including:

  • PBM economics, manufacturer contracting, and rebate administration

  • PBM client onboarding and implementation lifecycle

  • Compliance with federal and state PBM regulatory requirements, including:

    • Rebate passthrough requirements

    • Pricing transparency and detailed reporting mandates

    • Pharmacy reimbursement parity and benchmarking requirements

    • Statelevel PBM reporting and audit obligations

    • AnyWillingPharmacy standards.

    • Contract compliance, ERISArelated changes, and fiduciary requirements

    • Pharmacy complaint, dispute, and appeal processes

• Demonstrated success leading largescale compliance and regulatory programs and operational readiness initiatives within PBM, healthcare, pharmacy, managed care, or other highly regulated industries.

• Exceptional communication, executivelevel presentation, and stakeholdermanagement skills.

• Proven success leading and developing teams, including mentoring leaders and building organizational capability.

Education:

• Bachelor's Degree; equivalent years of related professional work experience may substitute

• Advanced degree preferred (JD, MBA, MPH, or related)

Pay Range

The typical pay range for this role is:

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.