Principal, Formulary Consulting

MedImpact Healthcare Systems, Inc.•San Diego, CA

1d•$114,622 - $206,321•Onsite

About The Position

MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team! Our success is dependent on innovative professionals with top-notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare. At MedImpact, we deliver leading-edge pharmaceutical and technology-related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution!

Requirements

BA/BS Degree; 8+ years related experience and 8+ years of SME in respective area(s); (or equivalent combination of education and experience)
Strong knowledge of Microsoft Office Suite software including Word, Excel, PowerPoint, and Others.
Moderate experience with SQL, database applications, financial modeling tools, reporting platforms, and enterprise project tracking tools is required.
Advanced Excel skills are required.
Valid Registered Pharmacy license in any of the state of the US
Superior working knowledge of all types of managed care pharmacy services with an emphasis on the relationship between managed health care and pharmacy benefit management.
Expertise in the advanced application of managed pharmacy practice and managed medical and prescription drug practices.
Good working knowledge of all types of pharmacy services, with an emphasis on the managed health care environment.
Expertise in administrative and operational application of pharmacy practice.
Excellent verbal and written communication skills with ability to persuasively present business propositions in a confident, trustworthy, and clear manner.
Ability to dynamically identify challenges and creatively develop solutions using a consultative sales approach.
PBM experience required.
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry.
Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
Ability to write reports, business correspondence, and procedure manuals.

Responsibilities

Proactively identifies, develops, and executes initiatives which optimize rebate yields and administrative fee revenue through an array of channels and processes, which includes developing and delivering value proposition statements (financial and clinical) with respect to rebate and formulary alignment opportunities to internal and external stakeholders who are responsible for formulary placement decisions.
Works independently and in collaboration with Pharmaceutical Manufacturers and rebate vendors in order to develop and implement processes, products, and methods which support rapid utilization conversions following formulary placement changes to quickly optimize rebate production.
Serves as an internal and external subject matter expert to the company and client plans related to contractual rebate terms, conditions, requirements, interpretation, compliance and overall rebate strategies; individually responsible for direct communications and relationships with high profile and strategic clients to educate, inform, recommend and persuade these clients to adopt changes that drive rebate yields.
Communicates tactical solutions to optimize rebate yield and reduce drug spend through a combination of formulary management techniques and pull-through initiatives to stakeholders throughout the enterprise (including Formulary Services and Drug Information) as well as to rebate clients in coordination with Account Management teams.
Responsible for rebate, net spend, and disruption modeling using direct and external rebate contract terms and client utilization, and for presentation of modeling results and recommendations to clients and account teams. Responsible for rebate performance and trending analysis for internal and externally sourced rebates and administrative fees.
Develops strategic and tactical solutions in coordination with the Director, Industry Relations and with the Formulary Business Review Committee to optimize rebate yield and reduce drug spend through a combination of contract design and coordinated execution of formulary management and clinical / utilization edits for all lines of business (Commercial, Medicare, Medicaid, Health Exchange).
Develops strategic and operational solutions for Risk Based Contracting and other innovative contracting initiatives in support of emerging rebate propositions.
Manages “Formulary and Rebate Optimization” staff to achieve established unit and company goals and objectives.
Collaborates with Rebate Operations management to evaluate of contract rebate eligibility qualifications with respect to each individual client plan for purposes of rebate qualification and calculation, supporting quality assurance efforts to ensure accurate rebate billing, collaborating with account management teams to support rebate initiatives, and other activities supporting the contracting strategy, implementation and performance.
Supports other departments throughout the company through establishment and cultivation of opportunities related to Pharma supported initiatives such as Medical Management coordination, aligning Patient Care Center initiatives, executive business briefings, communication and coordination of LDD distribution channels, member support programs involving Centers of excellence, pharmacoeconomic analysis projects, etc.
Actively participates in the formulary strategy development process with respect to formulary management opportunities that improve rebate yield and drive lower net costs for clients for MedImpact Standard formularies operating under direct and indirect rebate agreements. Participates in the Formulary Business Review Committee with the responsibility to generate recommendations for consideration by the committee with respect to MedImpact Standard Formulary changes as well as with aligned clients managing custom formularies, and to facilitate the implementation of approved formulary changes with pull-through support.
Coordinates with subsidiary and related companies with respect to Industry Relations strategies to enhance and optimize value creation across the enterprise.
Participates as a Subject Matter Expert (SME) member of the Formulary Committee, providing support of Formulary Committee product placement considerations through financial spend/utilization/rebate models, proposing formulary management recommendations for individual drugs and therapeutic classes, sharing market intelligence and industry analysis to assist in understanding the current and future drug marketplace, and contributing to the concepts and features associated with the overall formulary strategy intended to achieve corporate objectives of optimal rebate performance.
Participates and leads the annual Part-D formulary strategy process with respect to formulary product placement opportunities that improve rebate yield and drive lower net costs for clients.
Supports audits of rebates conducted by clients, pharmaceutical manufacturers, and CMS in terms of providing interpretation of Rebate contract language as it applies to individual client formularies.
This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written). One must be able to; manage difficult or emotional client situations; Respond promptly to client needs; Solicit client feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients.