Pharmacy Benefits Manager Account Director

Summary

The primary responsibilities of this position are to ensure customer satisfaction, build and maintain trusting relationships with client leadership, retain clients, escalate and resolve operational issues to meet contract expectations and assure operations are aligned with organizational priorities. The position manages the relationships between all stakeholders, develops the pharmacy benefit management business, assures appropriate data evaluation and ensures financial viability. This role partners with the market health plan CEO and other internal business partners.

Your role in our mission

• Serve as primary point of contact for the Ohio Single PBM
• Provide leadership throughout the Ohio PBM including strategic and operational oversight to drive operating model performance and implement strategic initiatives
• Ensures contract objectives and service levels are consistently met
• Partner with leadership team and stakeholders to define top areas for selling, general and administrative expenses and cost of service improvements and implement plans to achieve desired savings
• Oversee business intelligence across business segment to include data, analytics, and reporting requirements for new and existing operations
• Makes recommendations for improvements to meet customer expectations.
• Assures quality improvement initiatives are improving the value and cost effectiveness of PBM operations
• Leads presentations to client and makes routine client visits

What we're looking for

• Bachelor’s degree or equivalent combination of education and experience required
• Master’s degree in Business or Healthcare Administration preferred
• Pharmacy degree and licensure highly preferred
• 5 or more years of managed care pharmacy or PBM operations leadership experience required at the director level
• Experience with end-to-end pharmacy claims lifecycle, clinical operations, call center management, medication pricing methodologies, NCPDP standards, financial management and managed care statute
• Experience evaluating healthcare data/outcomes is required
• Strong presentation, negotiation, and communication skills required
• Demonstrated leadership ability to drive results across the PBM through team influence and collaboration in a matrixed / shared service organizational model required

What you should expect in this role

• This role will be onsite in Dublin, Ohio.
• Understanding of State and Federal regulations; familiarity with the requirements of accrediting organizations is required.
• Must be capable of interacting with medical specialties staff (MDs, Nurses, Care Coordinators, etc), and Pharmacy Leadership.

The deadline to submit applications for this posting is November 29, 2024.