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Job Details

CVS Health

Actuarial Director - Kidney Care/Value-Based-Care





Scottsdale, Arizona, United States

Job Description
Would you like to join CVS Health, a Fortune 4 company, as a cross-functional actuarial leader in a unique role supporting both the growing Kidney Care initiative and Caremark’s dynamic PBM business?
CVS Kidney Care, a new CVS Health company, has been launched as part of the company’s portfolio of initiatives to transform health care and make a real difference in the lives of people impacted by chronic kidney disease and ESRD. Today, 9 out of 10 individuals with Chronic Kidney Disease do not know they have it and over 100,000 individuals start in-center dialysis each year. The kidney industry needs to change with a greater focus on value and outcomes.
As Actuarial Lead Director, you would join as an individual contributor a broad team of finance, clinical health care, and data analytics professionals in key corporate initiatives through development of Value-Based contracts spanning from pay for performance guarantees, to full risk carve out. The over-arching goal will be to provide improved access to quality care for kidney disease populations, leading to improved outcomes and enhanced economic and practical efficiencies in this disease space.
Eventually, this role may also support Value-Based contracts for other diseases, such as Oncology or Gene Therapy conditions.
In addition, you will coordinate and participate with an extended team of actuaries providing support and consultation on innovative PBM trend-related guarantees, pharmacy trend risk analysis, new ways of using pharmacy data from Caremark’s 100M+ customers, and consulting for our various Fortune 500 employer clients.
In this role, you will be frequently engaging with various stakeholders and frequently working under tight deadlines. Some of your key responsibilities will include:
• Engagement with cross-functional internal stakeholders such as finance, clinical, product, network, and data analytics teams.
• Leveraging deep insight and knowledge in Value Based Care arrangements within networks of Kidney care providers and Health Plan partners to make recommendations on contract structures.
• Apply knowledge of predictive analytics, using both pharmacy and medical data across multiple data sources to provide guidance on risk, pricing, reporting, and reconciliation.
• Ownership of primary assumption development and modeling of Kidney Care risk arrangements.
• Presentations to Executive leadership, Provider Networks, and Health Plan partners.
• Ability to independently research publicly available data for market insights.
• Risk/benefit analysis of multiple plan design and financial variables, including feasibility and appropriateness of additional marketplace partnerships to successfully market and administer programs, while controlling risk.
• Provide support for broader actuarial department priorities, such as benchmarking or ad-hoc financial analyses, trend experience analysis, and commercial client consulting.
• Identify and drive forward opportunities of using data in innovative ways that differentiate the CVS in the marketplace providing guidance to data engineering teams to build scalable solutions.
• Effectively prioritizing within the project team and broader actuarial team.
To be successful, you will need to develop a solid understanding of the Risk Base Care arrangements, Pharmacy Benefit Management models, a customer-centric mindset, and an ability to analyze complex problems and drive solutions to completion. You will also need to be proven in your ability to work independently in a fast-paced environment and manage tight deadlines with the appropriate level of delegation and communication with team members and to effectively present technical information to executive audiences. As we continue to grow the Kidney Care initiative, being able to develop and influence new processes that fit business needs will be critical to current and future success. As the team experiences change, being a strong people leader will also be essential to success.

Pay Range
The typical pay range for this role is:
Minimum: 100,000
Maximum: 221,000

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications
* At least 7 years of experience or equivalent with a majority in healthcare/medical industry or Pharmacy Benefit Management industry
* Attainment of ASA or FSA designation

COVID Requirements

COVID-19 Vaccination Requirement
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.

Preferred Qualifications
* Experience working in Value Based Care start-up
* Experience in Pharmacy Benefit Management industry
* Exceptional self-directed ability to contribute to teams as an independent individual contributor.
* Diverse experiences that demonstrate an ability to learn quickly
* Able to synthesize complex information in complex tools to drive solutions
* Exceptional communication skills, including bringing clarity to complex situations to both technical and non-technical audiences, engaging with senior leadership and effectively managing tight deliverable timelines.
* Adaptability and ability to prioritize effectively
* SQL / SAS / data engineering experience

* Bachelor's Degree is required
* Master’s degree is preferred
* Equivalent Combination of education and experience may be considered.

Business Overview
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.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.