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Manager, Pharm Managed Care

Job: #2020-66525
Store Number: 8311
Store: Southeastern Grocers
Category: Store Support / Corporate
Position Type: Merchandising
Full-Time/Part-Time: Full-Time
Address: 8928 PROMINENCE PARKWAY BUILDING 200Jacksonville, FL, 32256
 

Title

 

 

Manager, Pharmacy Managed Care

 

 

Job Purpose

Responsible for developing and executing all aspects of the managed care process including contract negotiation, industry relationships and analytics. This role contributes to sales growth, expense control, gross margin enhancement, asset management, budgeting, and reporting as required by third party prescription programs. This role will develop and coordinate third-party and retail pharmacy interests with cross-functional departments within SEG to suggest more efficient ways of working.

 

Responsibilities

1.       Contract Management

Evaluate, negotiate and manage performance of third-party contracts as well as provide strategies for maximizing revenues from these plans.

 

2.       Audit Processes

Develop and implement store audit processes, training and communication for field staff to minimize recoupment by third party plans and state agencies. Review audit trends, and respond to third-party audits as required.

 

3.       Third Party Processes
Give direction in managing reimbursement/collection issues and provide strategy in the development of advanced third-party reporting to identify opportunities for increased collection revenue rates. Interface with accounting department to identify issues with pharmacy accounts receivable processes and make suggestions to enhance the program in order to manage and reduce third party write-offs. Manage the switch and 340b vendors maximizing process execution, revenue growth and financial outcomes.

 

4.       Plan and Program Management
Analyze, collaborate, and define tactics with the risk management department regarding the workers’ compensation program, identifying ways to improve compliance, reduce expenses and improve profitability. Provide guidance and feedback to total rewards for the team member pharmacy benefit plan as it relates to retail operations. Utilize pharmacy operations expertise on third party plans to analyze opportunities and develop programs to improve team member therapeutic outcomes and reduce plan administrative costs.

 

5.       Leadership

Manage a team to ensure optimal success of the managed care program, while contributing to sales growth. This role will coach and develop their team to strengthen the department’s opportunities for success.

 

6. Performs other job-related duties as assigned.

 

Qualifications

Education Required:

Bachelor's Degree

Course of Study:

Business or Health Care

Education Preferred:

Master's Degree

Course of Study:

Pharmacy

Relevant Experience:

6 - 10 yrs minimum

Language(s) Required:

English                                    

Supervisory Experience:

1 - 5 yrs minimum

Language(s) Preferred:

English & Spanish                 

Knowledge, Skills & Abilities Required:

·   Complete understanding on pharmacy managed care including contracting, MAC, audits, 340b, and modeling

·   Knowledge of retail pharmacy operations

·   Strong negotiation skills

·   Expert data analysis skills with regards to interpreting and identifying trends in the marketplace from an industry perspective

·   Experience being responsible for both financial and non-financial reporting deadlines

·   Ability to develop and implement reimbursement and pricing strategies to maximize sales and margin performance

·   Ability to collaborate with cross-functional teams and departments

·   Knowledge and experience in prescription claim submission and reporting

·   Experience in developing and executing business plans that expand the volume or scope of business

Knowledge, Skills & Abilities Preferred:

 

 

Job Location:

Store Support Center                    

Department:

 

Physical Demands:

While performing the essential functions of this position, the associate is regularly (67-100%)required to sit, use hands or fingers to handle, hold or feel objects, tools or controls, talk, see, hear and perform repetitive movements with both hands. The employee is occasionally (1-33%)required to stand or walk on carpet, tile or concrete, carry, push, lift or pull up to 10 lbs.

Working Conditions:

While performing the essential functions of this position, the employee is typically not substantially exposed to adverse working conditions.

Safety Risk Factors:

The employee is occasionally (1-33%)required to twist back and/or neck and walk on a slippery or cluttered floor surface.

Equipment, Tools, etc.:

While performing the essential functions of this position, the employee will be required to utilize a personal computer, telephone, printer, copy machine, facsimile machine and other general office supplies and equipment.

Schedule(s):

Varied schedules.

Travel Percent:

Occasional

Overnight:

Yes