Director, Managed Care
The primary purpose of this position is to facilitate the recommendation and implementation of corporate strategy with respect to contracting with Pharmacy Benefit Managers, health plans and the managed care marketplace. In addition, monitor contract terms and reimbursement to optimize managed care revenue and gross margin. Frequent independent judgments are essential. The incumbent is also required to perform all tasks in observance of Rite Aid’s brand and strategy and adhere to our core values and service attributes.
ESSENTIAL DUTIES AND RESPONSIBILITIES
The associate is responsible for the functions below, in addition to other duties as assigned
- Review, analyze, and assist with negotiations of Pharmacy Benefit Manager and Health Plan pharmacy reimbursement contracts
Interact directly with Pharmacy Benefit Manager and Health Plans to resolve issues and clarify contractlanguage and payment terms.
- Maintain relationships with major managed care organizations and Pharmacy Benefit Managers (PBMs) for the purposes of continued and new contracting, increasing revenue, and building business opportunities
- Increase pharmacy sales through strategic relationships and marketing of Rite Aid value-added services to Pharmacy Benefit Manager and Health Plans.
- Provide enhanced reporting and data for the purposes of focusing corporate pharmacy initiatives and directing pharmacy performance improvement (e.g., quality and performance programs, generic dispensing and formulary compliance, etc.).
This position directly supervises Managed Care Contract Administrator , and carries out supervisory responsibilities in accordance with Rite Aid policies and applicable laws. Responsibilities include interviewing, hiring, training, directing, rewarding, and disciplining associates; appraising associate performance; and resolving complaints.
Experience / Requirements
- Ten (10) years' of experience in pharmacy, managed care, health insurance, and/or pharmacy benefits managementpreferred
- Or equivalent combination of education and experience
- Bachelor’s Degree in Arts/Sciences (BA/BL) Lal, Legal Studies or Paralegal preferred.