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Independent Health Supervisor, Pharmacy Contracting & Network in Williamsville, New York

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Overview

The Supervisor-Pharmacy Contracting & Network is responsible for Pharmacy Benefit Dimensions’ negotiation of competitive pharmacy contracts, maintenance of a robust pharmacy network and oversight of Pharmacy Benefit Dimension’s generic pricing program.

The Supervisor will be responsible for PBD’s contracting process including network analysis, negotiation, contracting and operational implementation. The Supervisor will lead a cross functional team comprised of IH and PBD subject matter experts, including but not limited to the Vice President, IH Pharmacy Services and President of PBD, to determine network strategy. The Supervisor ensures the network meets all requirements in terms of geographic composition, regulatory compliance and pricing, and develops strategies to address any deficiencies. The Supervisor is responsible for overseeing PBD’s pharmacy reimbursement strategies and continuously driving for additional value.

Additional responsibilities include decision support analysis for broker/client RFP process, working with the Sales team to meet the needs of existing and prospective clients, and collaborating with Legal to execute all pharmacy contracts, addendums and amendments.

Qualifications

  • Bachelor’s degree is required in the areas of healthcare, finance or a business-related field; four (4) years of additional healthcare contracting experience may be considered in lieu of degree.

  • Four (4) years of experience in contract negotiation, financial impact analysis, and/or payer contracting and reimbursement; knowledge of pharmacy sourcing and/or supply chain management is strongly preferred.

  • One (1) year of progressive leadership/management responsibility required.

  • Demonstrated ability to influence, negotiate and operate collaboratively in a team partnership environment.

  • Ability to work with, manipulate and synthesize large datasets for analysis, performance measuring, key insights and presentation.

  • Solid written/verbal communication skills; effective presentation skills; project management and planning critical.

  • Strong conflict management skills with the ability to identify, research and resolve.

  • Demonstrated proficiency in navigating window-based applications.

  • Proven examples of displaying the PBD values: Trusted Advisor, Innovative, Excellence, Guardianship, Dedication and Caring.

Essential Accountabilities

  • Lead, a multi-functional team, including, IH and PBD to develop network strategies that best position our pharmacy products from both a competitive and margin standpoint, as well as to establish standards pricing methodologies.

  • Negotiate financial arrangements with pharmacy partners, ensuring that both the corporate, business and financial objectives are achieved in all initiatives.

  • Create and maintain pharmacy network contracts for both IH and PBD.

  • Oversee the generic pricing program (MAC) and ensure nationally competitive pricing in all channels (retail, mail at retail, mail order and specialty).

  • Work collaboratively to lead presentations and negotiations with pharmacy partners

  • Analyze RFP pricing specifications, pricing sensitivities, key proposal requirements and formulate strategies and pricing responses. Analyze contract language to ensure business risk is mitigated and compliance is adhered to.

  • Responsible for pharmacy pricing and network reports compiling metrics regarding contracts and credentialing.

  • Ensure contracted rates are properly recorded and communicated to the PBD claims processing system as well as any network databases.

  • Manage and monitor each client network structure and proactively communicate any changes.

  • Responsible for working with internal business owners to obtain analytics needed to support network initiatives and requirements

  • Develop and utilize management reporting mechanism tracking the status of all contracting projects.

  • Facilitate processes related to pharmacy networks including pharmacy terminations, performance guarantee and market share reporting.

  • Manage issue resolution with PBD/IH and pharmacies.

  • Evaluate, mentor and develop staff to maximize performance and job satisfaction.

As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here (https://www.independenthealth.com/AboutIndependentHealth/Careers/AdditionalEEO-AAPInformation) for additional EEO/AAP or Reasonable Accommodation information.

Current Associates must apply internally via their Career Worklet.

Independent Health, a not-for-profit health plan headquartered in Buffalo, NY, serves nearly 400,000 members and provides innovative health care products and benefits designed to engage consumers in their health and well-being. Established in 1980, our comprehensive portfolio of progressive products include HMO, POS and EPO products, Medicare and Medicaid plans, traditional indemnity insurance, individual and small group Exchange products, consumer-directed plans and health savings accounts, plus coverage for self-funded employers.

Independent Health has augmented its highly successful insured product portfolio with services employers and employees need to better manage their health care expenses through its affiliate companies, including the Independent Health Foundation, Pharmacy Benefit Dimensions, Reliance Rx and Nova Healthcare Administrators.

Our award-winning customer service, dedication to quality health care and unmatched relationships with physicians and providers has allowed us to be consistently recognized as one of the highest-ranked health insurance plans in the nation.

We do not accept resumes from headhunters, placement agencies, or other suppliers that have not signed a formal agreement with us.

We are committed to providing reasonable accommodations for qualified individuals with disabilities and disabled veterans. An applicant for employment in need of an accommodation to participate in the application and recruitment process should contact the Manager, Talent Acquisition in Human Resources at:

Talent@independenthealth.com or (716) 635-4800

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