Manager, Pharmacy Business Development

Moda Health•Portland, OR

11d•Hybrid

About The Position

Moda Health is seeking a Manager of Pharmacy Business Development with a focus on industry relations. This role requires foundational clinical pharmacy experience, strong business acumen, and a passion for partnering with pharmaceutical and biotechnology companies and other vendor partners. The position is responsible for developing strategic formulary approaches to manage medications across medical and pharmacy benefits, aiming for low net cost medication utilization. This includes reviewing rebate initiatives for medications covered under both pharmacy and medical benefits across various lines of business (commercial, Exchange, Medicare, and Managed Medicaid). The role involves facilitating or supporting project implementation with internal and external stakeholders and articulating value. The ideal candidate can work in a hybrid arrangement near the Portland, Oregon office, though remote status will be considered.

Requirements

Doctor of Pharmacy degree (Pharm.D.) preferred, or Bachelors of Pharmacy degree.
Current active and unrestricted Oregon Registered Pharmacist license, or eligible for Oregon licensure which is to be obtained within 60 days of employment.
Past supervisory experience managing a team.
Three to five years of managed care experience, time can be inclusive of training from an accredited managed care residency program.
Experience with Commercial, Medicare, and/or Medicaid lines of business.
Experience managing contracts, particularly with biopharmaceutical manufacturers and other pharmacy vendors.
Technical understanding of pharmacy claims processing information and systems.
Strong analytical skills and business acumen.
Ability to communicate and present technical information appropriate for the audience.
Ability to work independently and collaborate cross-functionally with various stakeholders.
Project management skills and the ability to plan and execute projects as assigned.
Commitment to service, organization values, and professionalism.
Ability to maintain confidentiality and project a professional business image.
Works well under pressure with frequent interruptions and shifting priorities.
Ability to work independently.
Proficient with Microsoft Office applications such as Word, Excel, Outlook, and PowerPoint.

Responsibilities

Lead industry relations and rebate strategies for medical and pharmacy benefit medications, and new and emerging therapies, across all lines of business.
Oversee all rebate partners and lead evaluations of new potential partners.
Identify and negotiate direct contracts with biopharmaceutical partners.
Identify, manage, and assess the value of unique vendor partnerships to advance pharmacy programs, including drug information resources, medical management organizations, digital therapeutics, and point of service solutions.
Responsible for ensuring compliance with rebate contracts, rebate terms within client contracts, and contracts held with other vendor partners.
Lead rebate modeling and optimize rebate scenarios and bid selections based on client specific goals and strategies.
Oversee pipeline developments, including market events and material changes to therapeutic categories, for new and emerging therapies, specialty, and traditional medications, and keeps internal and external stakeholders apprised of such events.
Develops educational materials as needed.
Leads custom formulary rebate offerings and recommendations for downstream clients.
In collaboration with other pharmacy leaders, develop enterprise-wide industry relations strategy.
Oversee, develop and manage Moda’s Industry Relations team.
Lead rebate offerings for existing therapeutic strategies which support ongoing formulary performance, but also identify new opportunities either as contracting changes or new market entrants are FDA-approved.
Work closely with vendor partners (PBM, medical management companies, others) on policy or formulary changes driven by cost analysis, including rebate considerations or contracting.
Support and/or lead client facing presentations within industry relations as necessary.
Responsible for information gathering with legal and/or regulatory teams to understand impact to current formulary strategies, with financial implications, to anticipate or plan for any potential compliance driven update due to changes in existing, or new and emerging states of business.
Monitor, anticipate changes, and prepare for pipeline and market events.
Develop concise, applicable, comprehensive, and timely communiques as assigned for members, providers, internal, or external stakeholders.
Provide clinical support services that intersect industry relations or business development, including but not limited to benefit design, formulary analysis, drug information, P&T participation, client support, and drug utilization management.
Contribute, update, and maintain policies and procedures related to industry relations.
Complete significant projects and performs all other related duties as assigned.
Follow the company HR policies, Code of Conduct, and all department policies and procedures including protecting confidential company, employee, and customer information.