Pbm Implementation Manager Jobs Near Me

Synergie Medication Collective is a new medication contracting organization founded by a group of Blue Cross and Blue Shield affiliated companies to serve both Blues and select independent health plans. Synergie is focused on improving affordability and access to costly medical benefit drugs - ones that are injected or infused by a health care professional in a clinical setting - for nearly 100 million Americans. The Trade Client Strategy Director liaises with Synergie Participants and manages clinical policies to comply with manufacturer contracts, implements Trade strategies and initiatives, and collaborates with and supports Synergie's Client Relations team for Trade related inquiries. This includes medical and pharmacy drug policies, cross benefit management, and rebate qualification for manufacturer contracts. This position will establish and maintain cross functional partnerships with internal teams to drive the identification, development and successful execution of Synergie's rebate programs. This position will be the primary Trade point of contact for Synergie's Participant facing activities and will support clinical decision making at the Participant level to comply with manufacturer contracts.

Primary Job Functions

• Consult with Client Relations team on Trade related inquiries, initiatives, and opportunity pull through with Participants

• Understands downstream impact of rebate and formulary strategy and can convey appropriate messaging to health plan participants for adoption of said strategies and policies

• Has working knowledge of PBM operations and understanding of drug and UM strategy and policy implementation

• Has experience in reading and interpreting pharmaceutical manufacturer drug contracts and understanding how to align terms and conditions and translate into UM policy and criteria

• Manage medical and pharmacy clinical policies with Participants to ensure manufacturer contract compliance

• Collaborate and support Client Relations team for Trade related inquiries from Participants

Partner with the following stakeholders:

• Analytics Team - Collaborate on drug trends and utilization data to inform clinical policy decisions, medical policy and formulary compliance, drug share shift and utilization management strategies

• Client Relations - Serve as Trade's primary point of contact for all Participant questions on Trade initiatives and manufacturer contracts and escalate issues as needed to Trade's leadership

• Clinical Team - Liaise with Clinical team to review clinical data and policy requirements as needed

• Invoicing Team - Maintain current library of Participant medical and pharmacy policies and support Invoicing team with manufacturer inquiries regarding clinical policies

• Product Team - Provide medical policy support for manufacturer related contracts including, but not limited to, cell and gene therapies and other outcomes programs

Education, Experience, and Certification

• Pharmacy degree and Pharm D. preferred

• 5-7 years of related work experience in healthcare, pharmacy benefit management (PBM), utilization management, pharmaceutical contracting, client relations, or analytical contracting

• Must be eligible to work in the United States without need for work visa or residency sponsorship

• Excellent verbal and written presentation skills

• Ability to establish rapport and build relationships at all levels within an organization

• Practical application of clinical data to drive financial value

• Strong business and financial acumen, with advanced proficiency in Excel and PowerPoint

Knowledge, Skills, and Abilities

• Pharmacy residency training or equivalent experience

• Experience within the PBM industry, Medicaid, Medicare, and health plans

• Experience with contract language and risk mitigation concepts

Travel Requirements: Up to 10% of the time.

Work is generally performed in a remote setting.

#LI-Remote

$155,000.00 - $175,000.00