Analyzes providers and creates strategic plan to shift drug utilization to lower cost alternative agents in key MAC (Maximum Allowable Cost)/LCA (Lower Cost Alternative) medical benefit therapy classes. Meets with specialists, staff and health plan representatives to message program opportunity to change prescribing habits when clinically appropriate. Requires strong relationships with health plan provider network team to partner on strategy and communication. Responsible for frequent and ongoing monitoring of market share performance by plan and identification of opportunities to continue to reach health plan goals. Establishes strong relationships with provider groups in order to identify other health plan opportunities.
Subject Matter Expert on MAC/LCA Categories: Initial and continuous learning of all stakeholder factors, concerns and preferences regarding each MAC/LCA category. Supports enhancements of health plan message and develop provider messaging for the overall program and each MAC/LCA category. Researches and creates (in coordination with marketing) internal and external materials to communicate product internally and externally to health plans and providers. Participates in monthly MAC meetings to provide physician office feedback. Supports development of additional MAC/LCA categories.
Develops and maintains industry knowledge and expertise by attending applicable annual specialist or specialty pharmacy meetings.
Provider Network Strategic Planning: Works with analytics to create a structure for identification and ongoing maintenance of market share performance for each MAC/LCA customer provider network. Works with health plan provider network team and when delegated, independently, to message top provider offices of program opportunity. Messaging includes face to face or conference calls with supporting leave-behind collateral as allowed by the plan. Develops strong relationships with the health plan network team and top provider groups including the MD specialist, CFO, practice administrator, biller, lead nurse, etc.
When appropriate, works to contract with providers on the MAC/LCA fee schedule and work with medical pharmacy strategy team to upsell additional health plans in the region. Performs outreach to offices about availability of new billing procedures if seen in the data that they are not utilizing.
Health Plan Engagement: Thoughtfully tracks all physician outreach and conversations in order to communicate internal, meaningful status updates and opportunities for improvement. Leverages framework to provide status updates to health plans as needed, but no less frequently than once per quarter at business reviews. Supports MAC/LCA implementation efforts with new clients and coordinate client needs for implementation (e.g. provider communication materials, policy enhancements, fee schedule modeling, operational improvements, etc.). If applicable, works with health plan on member specific communication for MAC/LCA programs and other identified member specific approaches. Supports medical pharmacy strategy and account management teams on health plan discussions regarding the MAC/LCA program as needed.
Vendor Collaboration: Works with external partners as needed to provide customer or provider with category subject matter expertise, such as Key Opinion Leaders, compounding pharmacies, etc. Partners with external vendors to present MAC/LCA program at annual MD specialist meetings or other meetings as identified.
Administration: Develops thoughtful, strategic travel itineraries. Responsible for leading and executing on pull-through initiatives such as provider mailings, collateral printing, etc.
Bachelors: Pharmacy (Required), Masters: Pharmacy, PharmD: Pharmacy
License and Certifications - Required
RPH - Registered Pharmacist - Pharmacy
License and Certifications - Preferred
Other Job Requirements
Minimum of 1 year of managed care, pharmaceutical manufacturer, or clinical position preferably with specialty drug focus.
Independent learner and worker, requires little direction, self-starter, attention to detail, high quality work, consistent tracking and follow-up, excellent verbal and written communication skills, comfortable with public speaking, analytical mindset and skills, works well and productively in a team environment, able to meet deadlines, comfortable with traveling, confident clinical aptitude, research capabilities, innovative, strategic, and organized.
Working knowledge of Microsoft Office Product Suite and Adobe Acrobat Pro.
Data review and interpretation skills required.