Job Description

Pharmacy Director - Aetna Better Health of Kentucky Join to apply for the Pharmacy Director - Aetna Better Health of Kentucky role at CVS Health This is a fully remote, work from home role. The ideal candidate will reside in the state of Kentucky. Position Summary The Pharmacy Director for Aetna Better Health of Kentucky will be responsible for all clinical, financial, operational and compliance activities related to the prescription drug benefit for the Plan. The Pharmacy Director is an integral member of the health plan executive leadership team and oversees and manages all financial and operational aspects of pharmacy and prescription drug services within the Kentucky Medicaid health plan, executing the Pharmacy Benefit in accordance with all statutes, regulations, and contractual requirements. Responsibilities Strategic Planning : Develop and implement strategic plans for pharmacy services that align with the organization's goals and objectives. Pharmacy Benefit Management : Manage the pharmacy benefit program, including benefit set-up, claims processing, contractual oversight, formulary management and updates, medication utilization review, prior authorization processes. Regulatory Compliance : Ensure compliance with state and federal statutes and regulations, stay updated on changing regulations, and lead discussions as the delegated health plan representative in state meetings. Provider and Vendor Management : Collaborate with pharmacy network providers and PBMs to ensure contracts are compliant, monitor reimbursement rates, and maintain positive relationships. Clinical Pharmacy Programs : Oversee development and implementation of clinical pharmacy programs such as MTM, disease management, drug utilization review, and medication adherence programs. Quality Assurance and Patient Safety : Establish and maintain quality assurance programs to ensure safe and effective use of medications, monitoring medication errors and adverse drug events. Financial Management : Work closely with the CFO and actuarial team to develop and monitor budgets, analyze financial data, identify cost-saving opportunities and optimize medication-related expenditures. Required Qualifications 5 years’ experience in managed care pharmacy Preferred Qualifications 5 years’ experience in Medicaid Managed Care pharmacy or residency in managed care pharmacy M.B.A. from accredited university Education B.S. or Pharm.D. from an accredited college of pharmacy Pay Range The typical base pay range for this role is $99,420.00 - $214,137.00 per year. Benefits Affordable medical plan options, 401(k) plan with matching company contributions, and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation, weight management, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits. Seniority level Director Employment type Full-time Job function Health Care Provider Industries Hospitals and Health Care Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. For more information, visit Application window closes on: 12/12/2025 #J-18808-Ljbffr CVS Health

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