Manager, Health System Pharmacy Revenue Integrity

Navitus Health Solutions, LLC

1d•Remote

About The Position

The Manager, Health System Pharmacy Revenue Integrity, is responsible for optimizing health system pharmacy strategies and programs to ensure financial resilience and success for partners of Lumicera Health System Solutions and Navitus Clients. The Manager and their team will work cross-functionally with teams at Lumicera and Lumicera-operated pharmacies to deliver value for partners through designing, implementing, and continually improving workflows and processes that achieve revenue and operating margin goals. In addition, this associate will provide subject matter expertise and guidance for Navitus and Navitus’ Clients seeking strategic guidance on health system revenue optimization. Achieving success in this position will be reflected by growing and maintaining revenue flow through health system pharmacy partners. Deploying strategies in drug purchasing, payor contracting, and site of care medication administration will be key areas of focus. Expertise in guiding compliant optimization of savings available through government programs including the 340B program and the Inflation Reduction Act Medicare Maximum Fair Price drug rebates to our partner organizations is also paramount. The ability to adapt to changes in the rapidly changing health system landscape will be key to delivering results expected. The ultimate goal will be to position Lumicera Health System Partners and Navitus Clients to sustain financial success through their pharmacy revenue strategy across the health system pharmacy program continuum.

Requirements

Bachelor’s degree in Pharmacy, Healthcare Administration, Finance, or related field, equivalent work experience, required.
5 years of overall pharmacy experience required.
5 years in a 340B Health System Program position, or equivalent experience, required.
5 years of program management experience required.
5 years of experience in Health System or IDN Pharmacy Operations, Specialty Pharmacy, Revenue Integrity, or Revenue Cycle Management required.
Experience with developing business cases, roadmaps, and program metrics required.
Demonstrated leadership skills include the ability to effectively develop and assist team members required.

Nice To Haves

340B Apexus Certified Expert (ACE) credential highly preferred. If not achieved at time of hire, ACE credential must be obtained within 12 months of hire date.

Responsibilities

Develop and maintain subject matter expertise in operational tools and software applications including, but not limited to, RxVector/Agile Care, NCRX, Lighthouse, CoverMyMeds, Lumicera Digital Engagement Programs for Patients and Providers, Manufacturer Patient Assistance Programs, Manufacturer Enhanced Services Programs, Phone System(s), CRM, Alvaria, Jira, and Electronic Medical Record navigation, communication, and documentation.
Partner with Health System pharmacy, finance, and revenue cycle leaders to ensure aligned charging, billing, and reimbursement workflows.
Provide financial impact analysis for new specialty therapies, biosimilars, site-of-care shifts, and program expansions.
Proactively communicate opportunities and risks for 340B program qualifications to Lumicera and Navitus partner organization leadership based on current and future changes to the 340B Program landscape.
Develop reporting and presentation on the current performance and additional opportunity analysis for Lumicera and Navitus partner organizations participating in the 340B program.
Support appeals strategies and remediation plans for recurring pharmacy reimbursement issues.
Effectively utilize analytics to track and trend successes and opportunities both internally at Lumicera, as well as externally with partners. Developing and maintaining subject matter expertise is expected in software applications including, but not limited to, electronic health records, 340B third-party administrator platforms, Qlik-Sense, Navigate 3D, Microsoft Excel, Microsoft PowerPoint, SharePoint, Cisco, Genesys, and Alvaria.
Develop and maintain policies and procedures in scope of 340B compliance and optimization for Lumicera pharmacy operations in relation to partnerships with Covered Entities.
Performs human resources responsibilities for staff which include interviewing and selection of new employees, promotions, staff development, performance evaluations, compensation changes, resolution of employee concerns, corrective actions, terminations, and overall employee morale.
May provide functional supervision to professional, paraprofessional, and support staff in their respective pharmacy, including training, assigning duties, and providing input for performance evaluations.
Identify and present opportunities for workflow and process improvement to direct manager and/or Lumicera Leadership.
Develop and update training resources that effectively facilitate education on the unique aspects of 340B specific to the IDN Specialty Pharmacy workflows, programs, and individual locations.
Represent Lumicera and affiliated IDN organizations with a high degree of professionalism in all interactions within scope both inside and outside of the workplace.
Other duties as assigned.