The Manager for Specialty Pharmacy portfolio within the GPO will:• Lead mid-and large projects to help develop strategic contracting opportunities to improve the economic and financial competitive position of the Blue System. • Provides senior management of business operations and project implementation for multiple national-scale Specialty Pharmacy, medical benefit focused initiatives. • Develops project plans which ensures end-to-end integration of project phases, as well as establishes supporting operational procedures. • The manager supports the Managing Director with the development of supplier relationships that provide strategic and tactical solutions for Blue Cross and Blue Shield companies. through data collection and analysis, interviews, application of expertise, literature reviews, supplier interaction and team interaction. • Specific emphasis will be placed on category/contract ownership, sourcing and negotiating with suppliers to maximize value.• Support the Managing Director with management of Advanced Therapy portfolio• Additionally, the Manager will be responsible for serving as the single point of contact/ Client Relationship Manager for several BCBS Plans and manufactures. • This role also assigns and monitors the status of deliverables and day to day responsibilities of direct reports and other matrixed project team members to ensure objectives and timelines are achieved.
Responsibilities include but are not limited to:
Portfolio & Plan Management
- Grows the category assigned both through the addition of new national agreements, agreement expansion and Plan adoption/utilization. Responsible for the day-to-day management of contracts assigned. Has the ability to acquire, organize and synthesize financial data and other information to identify and communicate key findings. Maintains financial viability and takes ownership of category.
- Responsible for administering pharmaceutical rebate contracts, including but not limited to:
- Creating bid (RFP) structures for each therapeutic class based on strategic direction from Healthcare Cost and Quality leadership
- Administering rebate offers/RFPs
- Supporting category sustainability and future growth
- Ensuring participating Plans meet rebate contractual requirements, such as formulary, coverage requirements, utilization management and other medical management methods
- Supporting oversight of end-to-end rebate administration, delegated to a third party and/or internally
- Analyzing rebate contract offers, including interpreting requirements and caveats and forecasting yields and return-on-investment
- Supporting manufacturer contract negotiations & able to negotiate amendments and small agreements independently
- Engages with Plans and suppliers routinely through 1:1 communications,meetings, presentations, webinars, etc.
- Interacts with pharmaceutical companies, participating Plans, Rebate Administrator and team to coordinate maintenance and growth of BCBSA's Specialty Pharmacy category
- Serves as the Client Relationship Manager/SME for s specific number of assigned BCBS Plans and manufactures. Develops deep knowledge of assigned stakeholders.
- Responsible for a portfolio of agreements valued at >$100M in spend annually and associated revenue
Program Development & Research
- Responsible for operations, people/project management, technical strategic direction and delivery of division/department initiatives one or more Practice Areas with the CareSourcing Specialty Pharmacy Practice Area. Maintains ownership of specific high-profile functions/set of services that include:
- Leading the development and management of a current and prospective participating Plan engagement program
- Manages pipeline monitoring for non-advanced therapies
- Provides project management of identified SPMBS future growth opportunities
- Makes recommendations to the Managing Director and engages team in the development of long term pipeline of opportunities to explore within assigned categories.
- Supporting Managing Director in cross-functional opportunities within BCBSA and Plans
- Supporting Managing Director in development of strategic partnerships and opportunities
- Conducts market research to validate category performance, identifies trends/new opportunities and is a subject matter expert within the category. Ability to interact with stakeholder staff and external suppliers to lead in collecting information and conducting interviews/surveys.
Required Basic Qualifications:
- Bachelors Degree Bachelor's degree in relevant studies
- A minimum of 5 years related business experience, relationship management or a technical discipline within the Pharmacy/Specialty Pharmacy (primary) and/or PBM/Pharmacy or hospital industry
- A minimum of 2 years experience overseeing and administering pharmaceutical rebate agreements both under the prescription benefit and/or medical benefit administration.
- 2 years stakeholder relationship management experience
- A minimum of 1 year of experience with medical claims data and/or pharmaceutical rebate administrator under the medical benefit
- Demonstrated project management and team leadership experience
- Strong oral/written communication and presentation skills
- Strong relationship management skills
- Strong analytical skills
- Strong project management skills
- Proficiency in Microsoft Office products (Word, Excel, PowerPoint)
- Knowledge of and practical application of coverage criteria under the medical benefit, formulary management, and other utilization management methods
- Demonstrated knowledge of rebate claim eligibility by line of business (Commercial, Exchange, Medicare, Medicaid) and pursuant to federal and state regulations (340 B, supplement Medicaid rebates, Best Price)
Equal Opportunity Employer
Blue Cross Blue Shield Association is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, national origin, age, gender identity, disability, veteran status, genetic information or any other legally protected characteristics.