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Managed Care Contracting Lead

Location: 

Smyrna, Georgia, United States

Job Function:  Market Access & Pricing
Job ID:  64902

Job Summary:

 

The Managed Care Contracting Lead will provide in-depth pricing and managed care market analysis to provide insights into business drivers and performance. The Senior Manager will assist in the development of managed care contract forecasts, develop and leverage contract performance assessments, and participate in contract review and negotiations. The Senior Manager will establish relationships with key business stakeholders to understand the key issues faced by their Payer Accounts and investigate creative and compliant contracting solutions, leveraging information (Quantitative & Qualitative) and analytics, to meet their need. The Senior Manager will be a forward thinker, generating insights into pricing and contracting scenarios, health care reform, and market trends for Market Access, Marketing, Finance (G2N) and Forecasting. The Senior Manager will also assist in the Channel Forecasting group in the maintenance of bottom-up payer channel forecasting models, providing payer forecasts from contract assessments.

 

Major Accountabilities/Responsibilities:

 

The Managed Care Contracting Lead will provide leadership and accountability across critical Top Tier US Pharmacy Benefit Managers (PBM’s) and Managed Care Organizations (MCO’s):

  • Acts as Primary Lead for a National Account Director, e.g. Express Scripts, and own Pre-Contracting, Redline, Rebates, and Contract Performance as the Single Point of Contact for Contracts & Pricing.
  • Maintains key understanding of Payer landscape, i.e. merger and acquisition of Cigna & Express Scripts, CVS Caremark & Aetna, plus Optum / United, and Prime Therapeutics with key Blues.
  • Acts as key stakeholder in Account business plan and execution including Strategy Creation, Account call planning and implementation, Rebate Bid Grid recommendations, plus presenting key aspects of business plan and contract performance.
  • Primary owner of Proposal Assessment Team – triage of accounts, calendar, proposals decks, final financial models, presentation of contract deals, notes, term sheets, and offer tracker. 
  • Supports Contracts & Pricing (C&P) Leadership Team in creation and presentation of content for Pricing & Contracting Committee.
  • Develops, refines and owns financial models to support contracting decisions, including modeling and analysis of innovative contracts.
  • Develops of pricing and forecasting techniques using multiple data sources including patient level data.
  • Assists in contract negotiations ensuring alignment of terms and conditions across Managed Markets, Legal, Contracting, Government Pricing & Reimbursement, and Brand Teams. 
  • Exhibits confidence and an extensive knowledge of emerging industry practices when solving business problems and pushes creative thinking beyond the boundaries of existing industry practices and client mindsets.
  • Demonstrates strong ability to work in a team environment and foster cross-team collaboration and creates a strong morale and spirit in the team through fostering open dialogue and collaborative atmosphere.
  • Partners with Managed Markets field team to identify ideal contracting options and alternative contracting options.
  • Analyzes and makes recommendations regarding the continuation/termination of existing contracts based on profitability and contract performance.
  • Completes special projects and other duties as assigned.
  • Potentially manage direct reports.

 

Qualifications:

 

  • Bachelor's Degree in Marketing, Finance, Business, Statistics, or related field.  MBA Preferred or equivalent relevant experience.
  • 5+ Years of demonstrated success in analysis and modeling, with preferred minimum of 5 years of pharmaceutical experience in Managed Care or Market Research.
  • Proven success in developing, implementing and interpreting advanced analytical models in a commercial setting.
  • Comprehensive understanding of complex data sources and the ability to leverage data in complex analytical models, including a comprehensive understanding of anonymous patient-level data and claims data.
  • Exceptional analytical skills with the ability to apply analysis to strategic evaluations of contracting strategy and pricing decisions.
  • Must be able to identify potential problems, conduct analysis and use judgment to determine if problem exists.
  • Excellent communication skills with the ability to consolidate complex concepts or calculations into meaningful internal dashboards and communications for sales, marketing, supply chain and senior management.
  • Microsoft Excel and PowerPoint super-user.

 


Job Segment: Pharmacy, Pharmaceutical, Supply, Market Research, Healthcare, Science, Research, Operations, Marketing

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