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 Executive Director, Fraud Waste & Abuse Clinical Services Operations, is accountable for the execution and operation of the fraud monitoring, detection, and prevention organization that supports our FEP client. This clinical leader will be responsible for implementation, compliance, delivery, and execution of Fraud Waste & Abuse programs for our largest employer client and their 36 BCBS Plan SIUs as well as version that supports the rest of the federal life clients. This includes leading the team that is

　　accountable for all financial, regulatory, and operational outcomes and expected to collaborate with all peers and colleagues at multiple levels to ensure adoption of new and existing client requirements.

　　Key ResponsibilitiesLead a diverse organization of FWA professionals including data analysts, clinicians and investigative colleaguesRelationship management and client retention for a large employer client and supporting the fraud units for other major clientsResponsible for the Member Quality Assurance program, a dedicated Fraud Waste & Abuse team for the Federal Employee Program (FEP) client.Responsible for a dedicated FWA platform (ADVC) including maintenance and process improvementDrives FWA and related benefit recommendations, product development and enhancementPartner with Finance and Forecasting teams frequently to develop and adhere to an annual business expense budget. Ensure that the overall operation maintains profitability and grows client valueOversee the FNRC (FEP Network Review Committee) process to ensure provider adherence to contractual obligations within the pharmacy network provider manualProvide responses to OPM Carrier Letters, questionnaires and audit requirementsEnsure all CMS guidelines are being adhered to in support for the FEP MPDP line of businessStrong emphasis on operations' employee recognition, coaching and development, and engagement.Sales and Account Management teams to successfully generate, create, and retain the BCBSA/FEHBP/Targeted client's business for both delegated and self-service CVS Health offerings,Support PBM Innovation and Product Teams on revamping and/or launching new products and services. Required Qualifications Approximately 8-12 years of experience in the PBM area. Strong knowledge of the PBM marketplace, including drug trends, utilization management and member/prescriber engagement.Proven People Leadership SkillsExperience presenting to senior level clientsExperience with the HPMS I-MEDIC Portal will be highly valuedExperience creating and managing a Drug Management Program (DMP) will be highly valuedExperience with the CMS Overutilization Monitoring System ( OMS) quarterly reports will be highly valuedAbility to understand State and Federal regulatory requirements while establishing the operational disciplines and controls to run a highly efficient and compliant operation.Experience responding to RFP/contract questionsPreferred Location: Phoenix - Hybrid (3 days in office)

　　EducationPharmD requiredPay Range

　　The typical pay range for this role is:

　　$178,750.00 - $385,000.00

　　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.

　　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 jobs.CVSHealth.com/benefits

　　CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

　　You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

　　CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through [email protected] If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.