Position Title: Director, Managed Care Operations
Functional Area: Pharmacy Department: Managed Care
POSITION PURPOSE:
The position is responsible for direct management and oversight of the contracting, implementation, and operations functions of our third party prescription programs and plans administered by Prescription Benefit Managers (PBMs), Managed Care Organizations (MCOs) and other private and public payers. The role includes accountabilities for overall managed care plan profitability and the negotiation of terms of participation with third party payers to grow Pharmacy sales and optimize margin. The position acts as liaison between Third Party Plans, Pharmacy Operations, Third Party Accounting, Pharmacy Systems, Clinical Services, Compliance and Legal.
KEY ACCOUNTABILITIES:
- Continually focused on building and maintaining a world-class team that addresses payer needs with appropriate resources and prioritization of value-added services and products, delivering substantial and profitable growth for the company.
- Provide proactive leadership, motivate employees, and function as an effective advocate for change and growth. Recruit, train and develop leaders. Ensure the right people are in the right jobs. Develop a can-do, goal-oriented, entrepreneurial environment that stresses employee performance, teamwork, management credibility and success. Cultivate a high-performance team through process, discipline, coaching and feedback.
- Helping to develop company strategy for payers. Have the ability to execute in the near term while charting the course for future years. Develop the business strategy in coordination with other senior management to achieve long-term objectives, as well as the development of new products, programs and services throughout the organization.
- Develop a tactical capability to optimize existing contracts.
- Develop an annual sales plan and budget, as well as quarterly forecast updates.
- Tracking and monitoring of third party plan financials and performance against forecasts and budgets using third party analytic resources
- Direct oversight of the Third Party Help Desk which supports field level pharmacy teams
- Direct oversight of the Third Party Administration team, including Plan Implementations and Store Enrollments.
- Oversight of the Pre/Post edit team
- Oversight of Managed Care Contracting and Credentialing including negotiating terms with PBMs, Managed Care Plans and Vendors
- Monitoring/Addressing contractual compliance of Third Party Payers
KNOWLEDGE AND EXPERIENCE:
- At least 5 years of pharmacy managed care experience dealing with major PBMs and third party plans.
- At least 5 years of negotiation experience involving multi-million dollar contracts.
- Experience with and knowledge of Medicare and Medicaid plan Compliance.
- Strong financial acumen. Understands pricing, budgeting, forecasting and is operationally astute.
- RPh or PharmD preferred, but not required.
- Proficiency in Microsoft Office Applications, i.e. Excel, Word, PowerPoint, and Access.
- Excellent Analytical skills.
- Excellent communication and presentation skills.
- Excellent time management, prioritization and organizational skills
- Must have at least 3 years of supervisory experience including performance management.
TRAVEL REQUIREMENTS: 10%
PHYSICAL ENVIRONMENT
Some travel may be required
Most work is performed in a temperature-controlled office environment
Incumbent may sit for long periods of time at desk or computer terminal
Incumbent may use calculators, keyboards, telephone, and other office equipment in the course of normal workday
Stooping, bending, twisting, and reaching may be required in completion of job duties
The above statements are intended to describe the general nature of the work performed by the employees assigned to this job. All employees must comply with Company policy and applicable laws. The responsibilities, duties and skills required of personnel so classified may vary within each department and/or location. EOE
