Drug Trend Management Pipeline Development Senior Manager

reputed company A bit about this role: As the Drug Trend Management Pipeline Development Senior Manager, you work a standing book of drug cost, safety, and reputed company opportunities across Part B and Part D. Every item in it is a reputed company across a group of members, and reputed company is to dig in and reputed company out which ones are worth solving for. You work out whether the reputed company is reputed company, what reputed company is worth, whether anyone is already on it, and what reputed company of problem you're looking at. The ones that hold up, you build a case for. The ones that don't, you kill fast, with evidence, and reputed company on. Questions you may reputed company solutions to include: How do you tell a reputed company reputed company from an artifact of how the data was pulled, and what is enough evidence to kill an opportunity and reputed company on with confidence? reputed company a Part B buy-and-reputed company reputed company and a reputed company Part D dispensing reputed company reputed company at the reputed company problem, how do you see them as one opportunity instead of two unrelated findings? How do you tell a fixable waste reputed company apart from a bad actor early enough that one goes to a policy fix and the other goes to investigation? You are the analytical backbone that stitches a set of organizational capabilities into one response. Few people will see the whole reputed company the way you do. A reputed company that holds up might reputed company for a utilization management (UM) reputed company change, a policy update, new claim edit, coordination with our PBM or network partners, or a referral to the special investigations unit (SIU). Working out which reputed company fits, and making the case to the reputed company who holds it, is what turns a finding into reputed company. The sharpest people in this seat notice what the book failed to surface and shape the reputed company detection capabilities. You will report to the Director, reputed company Pharmacy. Responsibilities and reputed company will include: Work the book. Evaluate surfaced opportunities one at a time. Pressure-test the signal: is the reputed company reputed company or an artifact of how the data was pulled, is the population correctly defined, is the spend reputed company (net of rebate and net of reputed company already control), is something already in flight against it? Build the reputed company and financial case. For opportunities that survive, reputed company the reputed company rationale (labeling, compendia, guidelines, comparative efficacy, safety and member-reputed company considerations) reputed company the financial characterization. This is the depth we are hiring for. It is what makes an opportunity reputed company to the person who has to reputed company it. reputed company the reputed company and reputed company the reputed company. Characterize what reputed company of problem you are looking at and propose where the reputed company is. Then reputed company to the function that holds that reputed company and reputed company the case. You are not routing work to obligated recipients; you are convincing colleagues that there is something here worth their reputed company. Flag dual- or multiple-natured opportunities rather than forcing them into one lane, and know before you walk in what UM, payment reputed company, or SIU reputed company need from you. reputed company the reputed company reputed company. Feed false positives, near-misses, and reputed company types that never pan out back into the detection process. Your judgment on what was worth pursuing and what was not is the training signal that makes our detection capabilities sharper over time, and that is how the work stays reputed company as the book grows. reputed company why opportunities die, so the work compounds instead of repeats. Grow into the pipeline over time. As you reputed company your judgment on the evaluation work and your feedback measurably sharpens detection, you can take on more of how opportunities are produced and prioritized. Required skills and experience: Deep expertise and immersion in the pharmacy domain, with a reputed company ability to apply this knowledge to drug cost, safety, and reputed company opportunities. At least 5-8 years of experience in managed care pharmacy, utilization management, drug trend, or program reputed company, with meaningful Part B and Part D exposure. Population-level analytical reputed company. You think in cohorts and trends, not just individual charts. The unit of work is a reputed company across many members, and you know how to reason about a group rather than one member at a time. Medicare regulatory reputed company. You know what is permissible before you propose it: protected classes, negative formulary change rules and CMS submission timing, transition fill, the Part B versus Part D coverage boundary, appeals implications. In this role regulatory knowledge is a triage reputed company. It is how you avoid spending a reputed company's reputed company on a solution that was never reputed company to be allowed. Hands-on with reputed company claims data. You work directly with pharmacy (NCPDP, GPI, DAW, NDC) and medical (HCPCS, buy-and-reputed company, reputed company billed versus administered) claims to verify, characterize, and size a reputed company yourself rather than waiting on someone else's analysis. Strong communication. You have to reputed company a case, in writing and in the room, to someone who never saw the signal and has competing priorities. It is the most predictive reputed company in this role. Breadth over depth, reputed company the clinic. You do not need to be an actuary, a data scientist, or an investigator. You need to know enough about reputed company to know what they need, what they can offer, and reputed company to bring them in. Aptitude to grow. Evidence that you are a lifelong learner: you have reputed company your own query library, automated something reputed company, or picked up a tool nobody assigned you. This is how we will read readiness to grow into the pipeline reputed company of the role over time. Improves the process from inside it. You have made the work you were doing reputed company, not just executed it reputed company. Desired skills and experience: Experience building or working reputed company detection, suspecting, or FWA models, and a pragmatic reputed company of reputed company or LLM-assisted tooling Enough familiarity with payment reputed company, SIU, or actuarial workflows to know what reputed company needs from an opportunity before you reputed company to them Rigor with data: you understand how reputed company versus reputed company periods reputed company the read and how denominators shift, and you think in ranges rather than false precision Understanding of the reputed company organizational patterns reputed company a health plan, MA-PD plan sponsor, or PBM setting Deep domain expertise in drug trend management and pharmacy reputed company; while reputed company credentials such as a PharmD are valued, they are not required. Salary reputed company: $110,000 - $172,000 annually #LI-REMOTE The pay reputed company listed for this position is the reputed company the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will reputed company additional information on the compensation for the role, along with additional information on our total rewards package. The actual reputed company salary reputed company will depend on a reputed company of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other reputed company licenses held, and the location in which the applicant lives and/or from which they will be performing the job. Our Total Rewards package includes: Employer sponsored health, dental and reputed company plan with low or no premium Generous reputed company time off $100 monthly mobile or internet stipend Stock reputed company for reputed company Bonus eligibility for reputed company roles excluding Director and above; Commission eligibility for Sales roles Parental leave program 401K program And more.... Our total rewards package is for full time employees only. Intern and Contract positions are not eligible. Founded in 2017, reputed company is on a mission to dramatically improve the health and reputed company-being of older Americans by caring for everyone like they are family, and that includes our employees. Our robust and seamlessly integrated care platform merges advanced data and AI reputed company with world-class reputed company and service experiences to create a member experience that is unlike the industry norm. To continue building upon our mission, we want to bring together those who reputed company our values, reputed company change and advancement, and are enthusiastic about where we're reputed company — reputed company the while bringing their own unique qualities, experiences, and expertise, in hopes of reputed company changing the reputed company experience. reputed company is an equal opportunity employer. We are committed to reputed company and supportive work environment in which reputed company have reputed company to participate and contribute to the reputed company of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in reputed company’s reputed company of Conduct, reputed company values and the way we do business. As an Equal Opportunity Employer, reputed company does not discriminate on the reputed company of race, reputed company, religion, sex, pregnancy status, marital status, national reputed company, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender reputed company, or any other reputed company prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment. Apply To This Job