[Hiring] Pharmacy Benefits Senior Manager @Devoted Health

Role Description

As Pharmacy Benefits Senior Manager, you will own pharmacy trend for our commercial book of business and become the person this organization trusts to tell the truth about where pharmacy dollars actually go. You will own the PBM relationship and the contract underneath it, decompose trend into unit cost and utilization until every driver has a name, build a savings pipeline that gets reconciled against what actually landed, and translate all of it into something a client can act on. You will also run the implementations (formulary changes, PBM transitions, plan-design rollouts) so every team involved, our client included, knows what is happening, what is next, and whether we are on time.

Questions you may find solutions to include:

• When our PBM tells us we saved $4M last year, how do we know whether that's real, and how do we show the client the difference between a discount that moved and a cost that actually came down?
• Our contract has 27 pricing guarantees. Which three actually determine our cost, are we measuring them the way the PBM measures them, and where is the reconciliation hiding the spread?
• A $2.4M gene therapy claim lands in Q1. What should already have been in place at the stop-loss layer, in the clinical policy, and in the client conversation?
• What are emerging best-in-class ways to manage trend? Who does it best, and could we do it better?

You will report to the AVP, Pharmacy. Pharmacy is one of the fastest growing costs for plan sponsors. We're hiring the person who is going to change that.

Qualifications

• 5-8+ years in pharmacy benefits, PBM operations/account management, payer/managed care pharmacy, or benefits consulting with demonstrable ownership of PBM contracting and drug-trend outcomes.
• Deep, current command of PBM economics: pricing/discount guarantees, rebates, spread, formulary and UM levers, and specialty drug management.
• Proven trend management track record.
• Strong analytics foundation: fluent with claims data, financial modeling, and BI tools; able to interrogate the math behind a PBM's reporting.
• Rigorous project/program management of complex, multi-stakeholder initiatives.
• Working knowledge of ERISA fiduciary obligations and CAA/RxDC transparency requirements.
• Outstanding communication skills.

Requirements

• Lead PBM procurement and RFPs; negotiate and re-negotiate contract terms (pricing/discount guarantees, dispensing fees, rebate guarantees, admin fees, definitions, audit and market-check rights).
• Track every performance and financial guarantee; commission and manage independent claims audits, rebate/pass-through audits, and mid-contract market checks; pursue and recover variances.
• Evaluate emerging PBM and contracting models (transparent/pass-through, cost-plus, unbundled/modular) and drive the build-vs-switch analysis and recommendation as the landscape changes.
• Own the pharmacy PMPM and total-cost-of-care number; decompose trend into unit cost vs. utilization and traditional vs. specialty.
• Build and run a savings-initiative pipeline as a disciplined project portfolio.
• Develop and monitor pharmacy trend KPIs.
• Run pharmacy as a portfolio of projects with owners, milestones, dependencies, and hard deadlines.
• Perform oversight of formulary and utilization management strategy for lowest net cost.
• Be the connective tissue across Finance, Legal, Compliance, Clinical, Data, and the client's HR/Total Rewards team.
• Operate as a prudent ERISA fiduciary and establish and run the process that satisfies the duty of prudence in selecting and monitoring the PBM.

Benefits

• Employer sponsored health, dental and vision plan with low or no premium.
• Generous paid time off.
• $100 monthly mobile or internet stipend.
• Stock options for all employees.
• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles.
• Parental leave program.
• 401K program.
• And more...