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Director, Pharmacy Financial Performance

4 months ago

New York, New York, United States Capital Rx Full time
Location: Remote (For Non-Local) or Hybrid (Local to NYC area)

Position Responsibilities:
  • Lead, develop, mentor and grow the team responsible for pharmacy reconciliations, pharmacy network pricing quality control/surveillance, pharmacy drug list management and pharmacy analytics.
  • Lead continued development, maintenance and monitoring of pharmacy network pricing and reconciliation models and the Company's pharmacy reporting infrastructure
  • Evaluate specialty pharmacy network pricing to ensure competitive rates both within our book-of-business and the PBM market
  • Coordinate with cross-functional teams to ensure network pricing is accurately produced and maintained
  • Lead function responsible for identifying potential pharmacy network pricing variances and drive timely resolution of variances
  • Utilize SQL queries and/or Python to manage, automate, and improve efficiencies of structured and unstructured data
  • Analyze benefit and network pricing testing files to ensure claims are accurately priced
  • Collaborate with other business functions (network, provider relations, clinical, underwriting, finance) to design, refine, and maintain internal pricing, modeling, and reporting SOPs
  • Develop KPI metrics and reporting to track progress on efficiency gains, issue resolution and successful mitigation of financial exposure
  • Support pharmacy appeals and ad-hoc requests related to drug pricing
  • Support the analysis and development of complex pricing models
  • Support general business needs and ad-hoc analysis, as required
  • Responsible for the adherence to the Capital Rx Code of Conduct including reporting of noncompliance
Minimum Qualifications:
  • Undergraduate bachelor's degree, with record of strong academic performance in Accounting, Finance, Actuarial Science, Statistics, Economics, Mathematics, or Business Administration
  • 6+ years of proven experience in financial analysis, actuarial services, accounting, pricing and underwriting, network pricing, or pricing operations
  • Prior PBM experience highly preferred
  • The ideal candidate will understand pharmacy pricing dynamics and have experience evaluating the financial performance of pharmacy plans with a focus on accuracy and attention to detail
  • Experience working with structured and unstructured data
  • Highly analytical; demonstratable knowledge of SQL, Excel, or other data visualization tools (Python or R experience preferred though not required)
  • Track record of leading cross-functional initiatives, driving high performance, meeting deadlines and executing on deliverables
  • Strong attention to detail with an intellectual and professional curiosity
  • Ability to balance multiple complex projects simultaneously
  • Exceptional written and verbal communication skills
  • Extremely flexible, highly organized, and able to easily shift priorities
Nothing in this position description restricts management's right to assign or reassign duties and responsibilities to this job at any time.

About Capital Rx

Capital Rx is a full-service pharmacy benefit manager (PBM) and pharmacy benefit administrator (PBA), advancing our nation's electronic healthcare infrastructure to improve drug price visibility and patient outcomes. As a Certified B CorpTM, Capital Rx is executing its mission through the deployment of JUDI, the company's cloud-native enterprise health platform, and a Single-Ledger ModelTM, which increases visibility and reduces variability in drug prices. JUDI connects every aspect of the pharmacy ecosystem in one efficient, scalable platform, servicing millions of members for Medicare, Medicaid, and commercial plans. Together with its clients, Capital Rx is reimagining the administration of pharmacy benefits and rebuilding trust in healthcare.

Capital Rx values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.