Sr. Director, Pharmacy Analytics and Strategy
About The Position
The Senior Director, Pharmacy Analytics and Strategy is responsible for pharmacy pricing oversight of Maximum Allowable Cost (MAC) as well as the execution, implementation, and optimization of current, new, and future network / pricing innovation. Responsible for network compliance including network performance guarantee reporting and pricing strategy as well as the execution, implementation, and optimization of current, new, and future network / pricing innovation. Will lead complex financial modeling and process development to create business insight, quality assurance, and execution to achieve departmental goals. Will lead complex financial modeling and process development to create business insight, quality assurance, and execution to achieve departmental goals. In partnership with other team leaders and members, develop reimbursement strategy, execute on network pricing, create standard and customized pharmacy network reports, and manage client / pharmacy analytics. Oversee NetOptimizer consulting opportunities that drive insights and cost-savings to clients. Develop capabilities specifically targeted to achieve the efficient and effective application of the company’s products and services toward the achievement of total cost savings and improved health outcomes for the company’s clients and their members.
Requirements
- Bachelor's degree
- Experience in Analytics including large data sets, MAC modeling, pharmacy / client Network management & reporting and process automation
- Excellent management and planning skills, detail oriented.
- Strong analytical and problem solving skills.
- Ability to organize and manage multiple priority tasks simultaneously.
- Proven and demonstrated project management skills, directing project activities to a cross-functional team.
- Problem solving ability in unstructured situations.
- Ability to lead effective meetings, accomplish goals and meet timelines.
- Ability to work well in cross-functional situations, giving clear direction and partnering with other internal departments to reach common goals.
- Ability to manage, mentor, and develop team members with expertise on MAC / Network pricing and the adjudication systems with particular emphasis on developing processes that are both accurate and efficient.
- Experience influencing change and adoption of new analytic capabilities to support pricing financial analytics.
- Experienced user of two or more of the following: SQL, SAS, Alteryx, Tableau, Power BI, R, or Python technologies.
Responsibilities
- Develop business, industry, competitive, client, and technical knowledge to formulate pricing strategy, and to execute financial modeling of comprehensive pricing strategies
- Consult with internal leaders and departments to coordinate relevant cross functional activities in support of network performance management efforts to maximize the organization’s competitive position
- Support GHP NetOptimizer consulting opportunities related to MAC / Network pricing including, but not limited to: generating financial models to reprice claims and calculate MAC pricing, network lease opportunities, data blending with reporting outcomes / compliance, provide insights on proposals, assist in implementation strategies
- Evaluate, track, and monitor pharmacy contracted network pricing terms and provide recommendations on pharmacy contract terms
- Execute and implement dynamic pricing strategies in response to market fluctuations to provide competitive, profitable, and best of class pricing offers
- Provide MAC Management support as needed including but not limited to, Pharmacy / Client Custom MAC evaluation and strategic recommendations to adhere to any applicable contracted Pharmacy GER reconciliation
- Develop and maintain ongoing analytics and processes for Brand Effective Management
- Manage client contract network guarantees to ensure accuracy and eliminate liability payments to clients
- Support additional consulting efforts where clients require custom pricing/network management
- Collaborate with the Underwriting team to provide recommendations on pricing / networks offerings and negotiation strategy to achieve revenue, profitability targets, and margin retention, for new and existing customers
- Provide consultative services to internal support teams for processes improvements
- Manage supporting analysts in all tasks aforementioned and provide continuous training where needed
- Proactive identification and closure of network gaps as well as development of performance reports
Benefits
- Comprehensive mental health and wellbeing resources
- Nationwide Blue Cross Blue Shield PPO with employee-friendly plan design, including a $850 individual annual medical deductible and $25 office visit copays, with low biweekly premiums
- Company-paid basic life/AD&D, short-term and long-term disability insurance
- Rx, dental, vision, other voluntary benefits, and FSA
- Employer-matched 401k Plan
- Industry-leading PTO plan
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What This Job Offers
Job Type
Full-time
Career Level
Director
