In this multi-disciplinary, cross functional role, the Manager, Pharmacy Pricing will report to the Director, Pharmacy Pricing & Analytics.
The Manager, Pharmacy Pricing is a leader and key contributor to the financial reporting and client retention process.
This role is responsible for leading the team that executes, updates, and provides strategic direction for existing client pricing.
The team also assists with resolving client issues involving performance discrepancies, claims issues, and reporting.
The successful Pharmacy Pricing Senior Manager will be able to manage multiple projects at once, lead a team, and champion our mission and culture.
Essential Job Responsibilities Include: End to end management of existing client pricing, analytics, and reporting.
Leadership of the pricing team, consisting of up to 10 direct reports.
This includes providing training, day-to-day direction, strategic vision, and mentoring/growth to all team members.
Ability to lead with influence across internal stakeholders to foster collaborative and efficient work products.
Review for accuracy and finalize all current account pricing comparisons for submission.
Provide strategic insight and support the AM and Deal Governance teams for At-Risk accounts.
Manage and support the current account claim and data requests.
Respond to competing PBM offers to show RxBenefits pricing value and defend at-risk accounts.
Prepare quarterly reports associated with financial performance.
Lead the production and delivery of all current account annual renewal reporting (Pricing refresh & comparison).
Support the PBM Pricing Analysts with validating new pricing products in Salesforce.
Perform key audits for new pricing enrollments and monthly contract guarantee performance.
Validate and test updates in SAS associated with pricing and exclusions to maintain reporting accuracy.
Research and analyze discrepancies between projected rebates and payments received.
Act as point of contact for the PBM partners to resolve pricing discrepancies.
Model pricing improvements related to PBM negotiations for improved renewal pricing and terms.
Identify gaps and opportunities in the current processes for enhanced visibility and efficiency.
Act as a cross-functional representative throughout the organization to provide strategic insight and support organization goals and initiatives.
Lead the development and application of advanced analytics techniques driving operational efficiencies, providing consultative support, enabling informed decision making, and producing KPIs for senior leadership.
Analyze data to uncover potential issues / provide financial impacts.
Provide custom analytics/modeling for ad-hoc projects.

Requirements

5+ years of actuarial or underwriting experience required
5+ years of PBM pricing or RFP experience required, large PBM experience desired
5+ years of leadership experience, preferably in PBM or Health Plan setting
High degree of emotional intelligence
Expert cross functional interpersonal, communication, and collaborative management skills
Advanced knowledge of Microsoft Office, Advanced Excel experience required
Proficient knowledge of SAS, SQL, Snowflake, or other data programming languages
Strong team building, relationship management, and project management skills
Independent/self-starting nature
Process and procedure oriented
Highly competent problem solver

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

actuarial experienceunderwriting experiencePBM pricing experienceRFP experiencedata programming languagesadvanced analytics techniquesfinancial reportingpricing modelingdata analysisproject management

Soft Skills

leadershipemotional intelligenceinterpersonal skillscommunication skillscollaborative managementrelationship managementproblem solvingteam buildingindependent natureprocess orientation