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Sr. Director, Client Services and Contracting: Managed Care
4 months ago
Responsible for driving revenue and referral retention by obtaining and managing OSPS PSAO, PBM contracts and providing access to all possible payors; working with clients to gain access to Specialty Pharmacy Networks; oversight of the Pharmacy Licensing team; and pharmacy PBM audit support teams. This position works collaboratively with the Sales, Operations, Client Solutions, Information Technology, Accounting, and Finance Teams to ensure all managed pharmacies are performing at the highest level.
Essential functions Helps create a payor business plan for each new client that includes employee program strategy, unique client payor contracts and specialty contracts associated with local, state and federal programs. Explores strategic opportunities to drive profitable prescription volume into our client pharmacies. Proactively manages the PBM contracts comprising the ReCept PSAO. Works to gain access to as many networks as possible to ensure prescription retention. Negotiates to keep reimbursement rates reasonable. Works closely with the Corporate Controller regarding contract terms impacting financials, direct and indirect renumeration fees, and other financially impactful contract issues. Assists client pharmacies with direct contracts with state programs and PBM area specific where required. Advises the SPS executive management teams of PBM activities and market changes to inform business decisions. Assists the Sales and the Client Solutions Team regarding PBM and payor presence in specified regions, and in any other way possible to ensure smooth openings. Ensures all pharmacy state licenses, and non-resident licenses are current; all Medicaid, DEA, Medicare, and any other regulatory organization information is current and accurate. Manages communication to all agencies when changes at a pharmacy occur. Assists clients with specialty pharmacy application submissions and associated quarterly and annual reporting. Provides PBM audit and recredentialing support for all managed pharmacies. Educates pharmacy teams on the PBM requirements regarding servicing their membership. Demonstrates knowledge of, and supports, mission, vision, value statements, standards, policies and procedures, operating instructions, confidentiality standards, and the code of ethical behavior. Performs other duties as assigned and required. education and experience Knowledge/Experience: Bachelor’s Degree in Sales, Marketing, Business or Degree in Pharmacy from an accredited college of pharmacy required, PharmD degree preferred. Minimum of 10 years progressive management and/or sales experience in the payor market with demonstrated ability to drive revenue growth. Significant knowledge of the specialty pharmaceutical and health care industry. competencies Ability to present to future and current clients. Sales and Marketing Proficiency. Financial analysis. Business Acumen. Skillful Communicator. Ethical Conduct. Professional credibility. Influence and negotiation skills. Initiative with ability to execute effectively on strategic plan. Identify, develop and leverage key relationships. Personal Effectiveness/Credibility. Problem Solving/Analysis. Strategic Thinking. Technical Capacity.