Job Description

Overview 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. This role is a fully remote, work-from-home position; the ideal candidate will reside in the state of Kentucky. The Pharmacy Director is a key member of the health plan executive leadership team, providing leadership, analysis, and guidance to the health plan and external partners for the state Managed Medicaid pharmacy benefit. What You Will Do Strategic Planning: Develop and implement strategic plans for pharmacy services that align with the organization\'s goals; identify opportunities for improvement; set performance metrics and long-term strategies to promote quality pharmaceutical care in a cost-effective manner. Pharmacy Benefit Management: Manage the pharmacy benefit program, including benefit setup, claims processing, contractual oversight, formulary management and updates, medication utilization review, prior authorization processes, and cost-effective drug utilization initiatives. Regulatory Compliance: Ensure compliance with state and federal statutes and regulations related to pharmacy practice and Managed Medicaid/PBM regulations; monitor changes and lead discussions on pharmacy program initiatives, Drug Utilization Review (DUR) and formulary/guideline changes. Provider and Vendor Management: Collaborate with retail, mail-order, and specialty pharmacies to ensure regulatory compliance and positive relationships; manage PBMs and other vendors to optimize access and cost management. Clinical Pharmacy Programs: Oversee development and implementation of clinical programs such as medication therapy management (MTM), disease management initiatives, drug utilization review, and adherence programs. Quality Assurance and Patient Safety: Establish and maintain programs to monitor medication safety, errors, and adverse events; collaborate across departments to support patient safety and HEDIS measures. Financial Management: Work with the CFO and Actuary team to develop and monitor the pharmacy budget, analyze financial data, identify cost-saving opportunities, and optimize medication expenditures. Required Qualifications Active Kentucky Pharmacist License 5 years of experience in managed care pharmacy Preferred Qualifications 5 years of experience in Medicaid Managed Care pharmacy or residency in managed care pharmacy MBA from an accredited university Education B.S. or Pharm.D. from an accredited college of pharmacy Pay Range The Typical Pay Range For This Role Is $99,420.00 - $214,137.00. This pay range represents the base salary for positions in this job grade. The actual base salary offer depends on factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program, and includes an equity award target. Benefits Affordable medical plan options, a 401(k) plan (including company matching), and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions addressing different needs and preferences, including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access, and other eligible benefits. For more information, visit This application window is expected to close on 11/28/2025. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Seniority level Director Employment type Full-time Job function Health Care Provider Industries Hospitals and Health Care Referrals increase your chances of interviewing at CVS Health. #J-18808-Ljbffr CVS Health

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