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Manager Pharmacy Contracting

Company: Highmark Health
Location: Nashville
Posted on: January 27, 2023

Job Description:

Company :Highmark Inc.Job Description :JOB SUMMARYThis job will provide direction and oversight to staff members for the end-to-end management of Highmarks traditional and innovative drug rebate contracts for activities including contract negotiation, financial modeling, contract execution, rebate invoicing and vendor oversight (as applicable). Serves as primary contact with pharmaceutical manufacturers and key vendors, including Pharmacy Benefit Manager. Engages with internal and external stakeholders to execute Highmarks drug contracting strategies and drive to low-net cost medication benefit offerings for customers. Oversees relationships with external client plans as part of Highmarks medical drug rebate administration program. Responsible for departmental compliance with contractual obligations and rebate administration for both Highmark and external client plans.ESSENTIAL RESPONSIBILITIES

  • Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
  • Direct and lead staff members in negotiating and executing drug rebate contracting strategies, which reduce spend and administrative costs and maintain a competitive position for Highmarks benefit products. Manages relationships with key internal and external stakeholders to develop and execute Highmarks strategic drug rebate portfolio across pharmacy and medical benefits. Directs end-to-end strategic and operational process for managing traditional and innovative drug rebate contracts including contract negotiations, execution, invoicing and vendor oversight (as applicable).
  • Oversees relationships with external client plans as part of Highmarks medical drug rebate administration program. Support external client plans in obtaining medical drug rebate opportunities aligned with their plans drug management strategies and philosophiesDirect staff members responsible for executing strategic and operational components of medical and innovative drug rebate contracts for external client plans.
  • Oversee relationship with Highmarks Pharmacy Benefit Manager engaged to provide pharmacy benefit drug rebate administration services. Collaborate with Clinical Pharmacy team during formulary management discussions to highlight the net financial impact of proposed formulary changes while supporting Highmarks clinical-first drug management philosophy.
  • Ensure compliance with government drug rebate reporting obligations of Highmark and any vendors (as applicable). Responsible for oversight of audit response from internal and external entities as related to drug rebate contracts.
  • Direct and provide oversight to staff and assist with planning and assigning projects to other staff members. Including but not limited to: Provide project lead instruction and direction to other staff regarding solutions to: meet business issues; Negotiate project deliverables: Anticipate impact and propose solutions; Research and analyze complex operational business processes or system applications; Adherence to standards/procedures to include obtaining pre- and post-implementation sign-offs.
  • Promote a culture of performance excellence departmentally by: Directing and encouraging quality process improvement and tools training/certification; Encouraging staff members to build and maintain effective relationships throughout organization to advance performance excellence.
  • Communicate effectively with all levels of the organization. Direct and encourage staff members to communicate effectively with all levels of the organization. To include: Identifying and articulating problems to senior management, steering committees and/or project sponsors; Developing business solutions to satisfy complex project goals and objectives; Conducting problem solving resolution and decision-making sessions for complex issues and projects; Establishing and maintaining customer touch points.
  • Other duties as assigned or requested.EDUCATIONRequired
    • Bachelor's degree in Business, Healthcare or related fieldSubstitutions
      • NonePreferred
        • Master's degree in Business, Healthcare (i.e., PharmD) or related fieldEXPERIENCERequired
          • 5 years in a drug rebate contracting process
          • 5 years in a Health Plan, Pharmacy Benefit Manager (PBM) or Pharmaceutical Manufacturer environment
          • 3 years in leading a strategic function within a managed healthcare environment (e.g., health plan, PBM)
          • 1 year in an external customer-facing rolePreferred
            • Experience leading pharmaceutical manufacturer rebate negotiations and contracting strategy
            • Experience in a Health Plan or PBM pharmacy department supporting strategic care cost savings initiatives
            • Registered pharmacist or Pharm DLICENSES or CERTIFICATIONSRequired
              • NonePreferred
                • NoneSKILLS
                  • MS Office proficiency
                  • Excellent verbal and written communication skills
                  • Strategic thinking skills
                  • Relationship- building skills
                  • Analytic and business solutioning skillsLanguage (Other than English):NoneTravel Requirement:0% - 25%PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONSPosition TypeOffice-basedTeaches / trains others regularlyOccasionallyTravel regularly from the office to various work sites or from site-to-siteRarelyWorks primarily out-of-the office selling products/services (sales employees)NeverPhysical work site requiredYesLifting: up to 10 poundsConstantlyLifting: 10 to 25 poundsOccasionallyLifting: 25 to 50 poundsRarelyDisclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Companys Handbook of Privacy Policies and Practices and Information Security Policy.Furthermore, it is every employees responsibility to comply with the companys Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.Pay Range Minimum:$92,300.00Pay Range Maximum:$170,800.00Base pay is determined by a variety of factors including a candidates qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.EEO is The LawEqual Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( )We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.orgCalifornia Consumer Privacy Act Employees, Contractors, and Applicants NoticeReq ID: J220710

Keywords: Highmark Health, Nashville , Manager Pharmacy Contracting, Healthcare , Nashville, Tennessee

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