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Managed Care Pharmacy Strategy Leader

Date:  Jul 20, 2022

Any city, OH, US, 99999

Req ID:  12800


The position will be responsible for evaluating clinical, financial, and operational trends of members enrolled in managed care plans.

They will perform analyses to help leaders shape the organizational strategy and develop measures to improve the cost and quality of care delivered through MCO partners.

Identification of improvement opportunities, oversight of care coordination, and leadership of clinical staff are key areas of responsibility.

Your role in our mission

•    Identify internal and external risks, key issues, and patterns from partial/conflicting data

•    Assess medical and pharmacy trend data - by MCO, by provider, by diagnosis, by drug …

•    Analyze and identify opportunities for improvement to the cost and quality of care by MCOs - at the individual member level, and at the aggregate level by population or health condition

•    Conduct research and analyses of operational effectiveness, processes, stakeholders, etc.

•    Identify processes that improve organizational effectiveness and build a sustainable competitive advantage

•    Present findings, projections and recommended actions

•    Plan, implement, and manage proposed recommendations and projects

•    Monitor and report on projects

•    Support and guide leaders through the decision-making processes

•    Plan, organize, and lead the activities of the clinical pharmacy and managed care liaison staff

•    Develop useful management reports and profiling

•    Provides input to the management team on a new product or service features 

•    Assess market trends and competitors

•    Identify threats and opportunities

•    Assists in development of RFP responses

•    Other duties as assigned/required.


What we're looking for

•    5 years of managed care, insurance, or pharmacy benefit management experience required.

•    Oversight of multiple areas within managed care preferred

•    Medicaid experience required.

•    3-5 years of business administration, management consulting, or strategic planning experience preferred

What you should expect in this role

  • Opportunities to travel through your work (0-10%) 
  • Remote location 

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