Sr. Manager, Managed Care Contracts

Ahold Delhaize•Pleasant Hill, CA

4d•Hybrid

About The Position

Contributes to the growth and profitability of Brand pharmacies through contracting and relationship management activities with Managed Care payers. Responsible for Managed Care pharmacy network negotiations, contract implementation and management, performance monitoring, and relationship management. Primary external point of contact for Brand pharmacies to Pharmacy Benefit Managers (PBMs), Health Plans, Large Employer Groups and other entities that sponsor pharmacy provider networks. Negotiates on behalf of the Brands for inclusion in narrow or limited Managed Care payer networks and contractual terms, conditions, and financial terms that support the Brand strategic plans, goals, and financial objectives. Responsible for communicating financial implications to brand teams, and accounting counterparts. Manages a team responsible for payment analysis, claims rebilling, contractual implementation, and compliance standards execution.

Requirements

Bachelor’s Degree
3 + years financial services experience
Relevant pharmacy industry experience
Applicants must be currently authorized to work in the United States on a full-time basis.

Responsibilities

Manages activities supporting Brand participation in Managed Care pharmacy provider networks, including: solicitation of provider agreements, review and proposal of contract language, negotiation of reimbursement rates, and contract management and retention.
Negotiates on behalf of Brand pharmacies and aligned with Brand strategic plans and financial objectives for inclusion within payer networks, including national, regional, and local broad and narrow networks sponsored by commercial or governmental payers.
Provides financial analysis of solicitations and communicates to brands and provides as inputs to budgeting and forecasting processes.
Manages relationship with switch, Medicare/medical vendors and accrediting bodies, overseeing team to create edits and communicate to brand operations.
Provides oversight and support of pharmacy claims processing, transactional analysis and contract performance management including analysis and reconciliation of effective rate contracting & DIR or performance rebate impacts, as applicable.
Builds and retains relationships with key payer network sponsors firms, including health plans, large employer groups, Medicare Plan sponsors, etc.
Responsible for financial analysis and management guidance regarding new or adjusted payer network proposals, including reimbursement rates, contractual terms, compliance standards, and performance-based fees.
Accountable for the execution and retention of all payer network agreements on behalf of Brand pharmacies.
Primary point of pharmacy network sponsor contact on behalf of the Brands and responsible for the receipt, review and response to inbound payer communication as well as network provider manuals.
Additional job duties may be assigned as needed to meet the needs of the business and support our Values.