Manager, Pharm Managed Care
Manager, Pharmacy Managed Care
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.
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
4. Plan and Program Management
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.
Course of Study:
Business or Health Care
Course of Study:
6 - 10 yrs minimum
1 - 5 yrs minimum
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:
Store Support Center
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.
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.