Walgreens

Manager, Payor Operations and Solutions

Walgreens • $100K — $120K *
Deerfield, IL 60015In-Person
Healthcare
Less than 5 years of experience
Today
Be an Early Applicant
Job Overview by Ladders

Qualifications

  • Bachelor's degree with 2+ years in healthcare OR High School Diploma with 4+ years in healthcare.
  • 2+ years performing analysis, administration, or operations in healthcare.
  • Experience developing strategies with internal resources to meet budgetary and timeline goals.
  • Analytical skills for reporting data, identifying trends, and driving improvements.
  • Experience resolving operational issues with effective strategies.
  • Advanced skills in Microsoft Excel, including pivot tables.
  • Intermediate skills in Microsoft Word and PowerPoint.
  • Minimum 1 year in project management and leadership roles.

Responsibilities

  • Lead and implement processes to enhance the analytics group.
  • Monitor contract compliance and proactively address deliverables.
  • Manage the lifecycle of Managed Care contracts.
  • Collaborate on contract reviews to ensure operational feasibility.
  • Oversee technical issue tracking with Third Party Providers.
  • Coordinate governance processes and performance reviews with stakeholders.
  • Train personnel on Payor-related processes and updates.

Benefits

  • Comprehensive healthcare coverage options.
  • Opportunities for career development and training.
  • Flexible work schedules to support work-life balance.
  • Travel opportunities for business-related purposes.
  • Collaborative work environment with cross-functional teams.
Full Job Description
Job Description

Job Summary

Responsible for leading and directing activities associated with the operations, implementation and maintenance of executed contracts for third party programs (e.g. retail pharmacy, mail service, specialty pharmacy, infusion, take care retail clinics). Works cross-functionally (e.g. Sales, Store Operations, Marketing, Purchasing, Advertising, Information Technology, Accounting, Finance, Logistics, Distribution and Law) to coordinate contract administration for pharmacy and medical benefit programs including processing, billing, reimbursement, formulary and payment information. Ensures that policies and procedures are revised and implemented to address any operational issues that are identified on the Walgreens side. Knowledge and understanding of products and services, store/field operations and contracts as well as knowledge of the managed care and insurance industries and their respective business issues and potential opportunities.

Job Responsibilities
  • Partners with the management team to identify, develop, and implement appropriate approaches, processes, and tools that elevate the analytics group.
  • Monitors the contract terms and commitments to assure all deliverables are adhered to and take proactive measures before key milestones are missed. Monitors the implementation process for all third party programs, while balancing client needs and company objectives to ensure a successful/positive implementation for both parties. Ensures maximum gross sales and profit by working closely with Contracting Directors/Managers through the ongoing review and confirmation of any non-standard third party plan setup requests. Works with corporate and field on any reimbursement issues, and brings exceptions or non-standard requests to the attention of senior management where appropriate. Maintains communication regarding third party participation, contract compliance, and any other operational issues or opportunities.
  • Manages the tracking, approval, administration, and post-implementation process of all Managed Care contracts throughout the contract life cycle.
  • Works with Contracting Directors/Managers to review Third Party Managed Care Contracts to ensure operational requirements can be met and implemented.
  • Monitors the technical links between the Third Party Provider and data tracking systems to assure reported issues are properly captured, reported, prioritized and managed to closure.
  • Oversees a Third Party Governance Process including periodic status calls, quarterly performance reviews, annual business planning, change order reviews and Third Party budgets/ costs. Conducts periodic meetings/ calls with internal departments to address administration issues, and coordinates resolution with the Service Provider as required.
  • Trains and provides ongoing education to personnel, customers, contractors, etc. on processes and procedures to address Payor related issues, updates, and opportunities. Works with appropriate internal and external parties to load and update new/existing location, market, and provider information.
  • Manages and audits the loading and updates of pricing and reimbursement terms to ensure contract compliance and appropriate profit and reimbursement.
  • Creates and oversees the training schedule of new employees as well as participate in a significant amount of training for new and existing employees. Provides analytical guidance, mentoring, and coaching to the team and peers.

External Basic Qualifications

  • Bachelor's degree and at least 2 years of experience in healthcare industry OR High School Diploma / GED and at least 4 years of experience in healthcare industry.
  • At least two (2) years' experience in performing a combination of analysis, administration, or operations in the healthcare industry.
  • Experience collaborating with internal and resources to develop strategies that meet department goals within budget and established timelines.
  • Experience with analyzing and reporting data in order to identify issues, trends, or exceptions to drive improvement of results and find solutions.
  • Experience in identifying operational issues and recommending and implementing strategies to resolve problems.
  • Advanced level skill in Microsoft Excel (for example: using AVERAGE function, merging and centering cells, printing centered page and/or creating a pivot table).
  • Intermediate level skill in Microsoft Word (for example: creating and modifying text styles, numbering and sorting lists, working with sections and columns, formatting tables, and using templates and using diagrams and drawing tools)
  • Intermediate level skill in Microsoft PowerPoint (for example: creating presentations, adding and removing slides, entering and formatting text, applying design templates, modifying masters, inserting graphics and objects, creating handouts).
  • At least 1 year of project management
  • At least 1 year of direct leadership, indirect leadership and/or cross-functional team leadership.
  • Willing to travel up to/at least 15% of the time for business purposes (within state and out of state).


Preferred Qualifications

  • MBA
  • At least two (2) years' experience implementing contracted Third Party programs in the healthcare industry.
  • At least two (2) years' experience administering healthcare contracts.
  • At least two (2) years Payor and facility credentialing experience.
  • At least two (2) years medical reimbursement/fee schedule maintenance experience.
  • Infusion, Specialty Pharmacy, Retail Clinic, and/or Pharmacy Technician experience.
  • Experience using Walgreen proprietary systems (e.g. AS400, SIMS, POS, IC+)
  • At least 2 years experience working in retail pharmacy operations.
  • At least 2 years working collaboratively with cross-functional teams.
  • Experience in identifying operational issues and recommending and implementing strategies to resolve problems. This would include using business and analytical skills to facilitate requirement sessions and documenting activity workflows and business requirements. Such process would involve experience in the direct and indirect management of team members, including assisting in the development, training and assignment of work/projects to other team members.

About Walgreens

Walgreens is the nation's largest drugstore chain with fiscal 2010 sales of $67 billion. The company operates 7,689 drugstores in all 50 states, the District of Columbia and Puerto Rico. Each day, Walgreens provides nearly 6 million customers the most convenient, multichannel access to consumer goods and services and trusted, cost-effective pharmacy, health and wellness services, and advice in communities across America. Walgreens scope of pharmacy services includes retail, specialty, infusion, medical facility, and mail service, along with respiratory services. These services improve health outcomes and lower costs for payers including employers, managed care organizations, health systems, pharmacy benefit managers, and the public sector. Take Care Health Systems is a Walgreens subsidiary that is the largest and most comprehensive manager of worksite health centers and in-store convenient care clinics, with more than 700 locations throughout the country.

Walgreens Careers

Joining Walgreens means becoming part of a team dedicated to inspiring health and well-being across America. As a cornerstone of the community, Walgreens offers unparalleled job opportunities in the retail and healthcare sectors, making it an ideal place for professional growth and innovation. Work You’ll Do At Walgreens, every position contributes to our mission of delivering premier health solutions while ensuring a diverse and inclusive workplace that fosters growth. Our team members are at the forefront of transforming customer experiences through dedication and expertise. Lead with Innovation and Leadership Embrace the opportunity to lead at Walgreens, where we combine industry expertise with a culture of innovation. Our leadership is committed to nurturing a professional environment where ideas thrive and leadership skills are honed through comprehensive diversity training and leadership development programs. Engage in Meaningful Work Join a team that values hard work and creativity, where your skills will be enhanced through challenging projects and collaborative team efforts. Walgreens is not just about filling prescriptions—it's about offering solutions that promote healthier communities. Explore Career Opportunities Whether you're looking for an entry-level position or a more advanced professional role, Walgreens offers a range of career paths in dynamic business areas. From in-store roles to corporate support, our job opportunities are designed to fit a variety of skills and interests. Internship and Employment Benefits Start your career with a Walgreens internship and gain hands-on experience that paves the way for future employment. Our interns work on real projects that matter, gaining skills that are crucial for future success. Full-time team members enjoy a wealth of benefits, including comprehensive health coverage, retirement plans, and exclusive employee discounts. Invest in Your Career Growth Walgreens is committed to the career development of our employees. We provide resources and training that encourage continuous learning and career advancement. With support for certifications and networking opportunities, team members can expand their professional horizons and achieve their career goals. Stay Connected Join Our Team Discover the diverse range of hiring opportunities at Walgreens by exploring open positions that match your skills and interests. We are looking for passionate, curious, and solution-driven team players ready to make a significant impact. Keep Up to Date Stay informed with career tips, insider perspectives, and industry-leading insights you can put to use today—all from the people who work at Walgreens. Job Alert Emails Customize your subscription to receive job alerts, the latest news, and insider tips tailored to your preferences. Explore the exciting and rewarding opportunities that await at Walgreens. At Walgreens, we are excited to see where your ambition takes you. Join us and be part of a team that is dedicated to shaping the future of health and wellness for everyone.
Learn more about Walgreens
Size
202,000 employees
Market Cap
$32.8 billion
Industry
Retail & Consumer Goods
Net Income
-$696 million
Founded
1901
5 Year Trend
+2.3%
Revenue
$141.5 billion
NASDAQ
WBA
* Ladders Estimates

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