Primary Job Functions
Consult with Client Relations team on Trade related inquiries, initiatives, and opportunity pull through with Participants
Understands downstream impact of rebate and formulary strategy and can convey appropriate messaging to health plan participants for adoption of said strategies and policies
Has working knowledge of PBM operations and understanding of drug and UM strategy and policy implementation
Has experience in reading and interpreting pharmaceutical manufacturer drug contracts and understanding how to align terms and conditions and translate into UM policy and criteria
Manage medical and pharmacy clinical policies with Participants to ensure manufacturer contract compliance
Collaborate and support Client Relations team for Trade related inquiries from Participants
Partner with the following stakeholders:
Analytics Team – Collaborate on drug trends and utilization data to inform clinical policy decisions, medical policy and formulary compliance, drug share shift and utilization management strategies
Client Relations – Serve as Trade’s primary point of contact for all Participant questions on Trade initiatives and manufacturer contracts and escalate issues as needed to Trade’s leadership
Clinical Team – Liaise with Clinical team to review clinical data and policy requirements as needed
Invoicing Team – Maintain current library of Participant medical and pharmacy policies and support Invoicing team with manufacturer inquiries regarding clinical policies
Product Team – Provide medical policy support for manufacturer related contracts including, but not limited to, cell and gene therapies and other outcomes programs
Education, Experience, and Certification
Pharmacy degree and Pharm D. preferred
5-7 years of related work experience in healthcare, pharmacy benefit management (PBM), utilization management, pharmaceutical contracting, client relations, or analytical contracting
Must be eligible to work in the United States without need for work visa or residency sponsorship
Excellent verbal and written presentation skills
Ability to establish rapport and build relationships at all levels within an organization
Practical application of clinical data to drive financial value
Strong business and financial acumen, with advanced proficiency in Excel and PowerPoint
Knowledge, Skills, and Abilities
Pharmacy residency training or equivalent experience
Experience within the PBM industry, Medicaid, Medicare, and health plans
Experience with contract language and risk mitigation concepts
Travel Requirements: Up to 10% of the time.
Work is generally performed in a remote setting.
#LI-Remote
$155,000.00 - $175,000.00This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the hiring range and this hiring range may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs. This job is also eligible for annual bonus incentive pay.
We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.
Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
Skills Required
- 5-7 years related work experience in healthcare, PBM, utilization management, pharmaceutical contracting, client relations, or analytical contracting
- Must be eligible to work in the United States without need for work visa or residency sponsorship
- Working knowledge of PBM operations and drug and utilization management strategy and policy implementation
- Experience reading and interpreting pharmaceutical manufacturer drug contracts and aligning terms into UM policy and criteria
- Manage medical and pharmacy clinical policies to ensure manufacturer contract compliance
- Experience collaborating with analytics, clinical, invoicing, and product teams on drug trends, policy, and rebate programs
- Excellent verbal and written presentation skills
- Ability to establish rapport and build relationships at all organizational levels
- Practical application of clinical data to drive financial value
- Strong business and financial acumen with advanced proficiency in Excel and PowerPoint
- Pharmacy degree
- PharmD
- Pharmacy residency training or equivalent experience
- Experience with Medicaid, Medicare, and health plans
- Experience with contract language and risk mitigation concepts
What We Do
Blue Cross Blue Shield Association is a national federation of 34 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide health care coverage for one in three Americans. BCBSA provides health care insights through The Health of America Report series and the national BCBS Health Index.
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