CareFirst Careers

Pharmacy Value Solutions Director

Resp & Qualifications

This key Leadership role is critical to CareFirst’s ability to effectively drive value across the Pharmacy line of business within the Specialty Business Unit.  The Director will have a clear understand of how to maximize the constructs of our PBM contract, then translate that value back to our clients – all while identifying additional ways to increase revenue for CareFirst. The Director will proactively review all aspects of pharmacy related data to provide strategic subject matter expertise to analysis and consultative recommendations on financial strategies to maximize and grow CareFirst’s presence in the market. In addition, this role will support sales and underwriting as they work with accounts to guide future benefits decision-making. The incumbent will provide insight and the ongoing monitoring to evaluate and validate implemented recommendations, outline and recommend strategic financial actions across all the key pharmacy financial levers.
 

PURPOSE
This strategic leadership position will oversee a consultative team of Pharmacy Business Consultants, data and informatics specialists and other key analysts.  This high impact team consults across CareFirst customer segments; particularly, Large Group and CFA, to ensure the CareFirst pharmacy financial value proposition is understood by consultants and brokers. 

The Director, Pharmacy Value Solutions is responsible for the development of new business opportunities, supporting existing client and broker/consultant relationships specific to articulating the financial positioning of the pharmacy business. The Director acts as the voice of the market internally, making strong, data-driven recommendations that translate into high-value pharmacy initiatives. As the financial pharmacy expert, the Director’s primary focus is on data analysis, pharmacy industry trends and enhancing internal and external reporting based on the feedback received from the market in conjunction with our PBM partner.

PRINCIPAL ACCOUNTABILITIES:
Under the general supervision of the VP, Specialty Business the incumbent’s accountabilities may include, but are not limited to, the following:


1. Pharmacy Revenue and Pharmacy Data Analysis & Consultation

The Director will ensure the timely analysis and communication of pharmacy financial and revenue trend drivers, working closely with CareFirst’s Data and Informatics teams, Underwriting and Specialty.  He/she will monitor critical data elements and produce actionable insights for CareFirst’s Executive Leadership. 

  • Monitors pharmacy revenue trends and works towards Benchmarking and ROI initiatives
  • Advises and consults analyzing pharmacy PBM contracts/vendors to maximize CareFirst and customer value
  • Works with internal and external partners to identify opportunities to drive revenue growth, margin expansion and a more favorable mix (i.e., driving preferred products and services).
  • Analyzes and makes recommendations about the CareFirst Pharmacy rebates and recommends optimum strategy
  • Understands pharmacy market dynamics and competitors. Conducts complex analysis, synthesizes and summarizes implications to business, influencing business partners using analytics and business understanding.

2. New Business and Existing Account Support

  • Support sales and UW as subject matter expert at consultant, client meetings and public events where detailed financial analysis related to pharmacy costs are required. 
  • Assists sales and account executives with market share growth and retention by the development and implementation of consultative pharmacy strategies specifically designed the account to increase market penetration and ensure retention of the account or sale of new products and/or new accounts.
  • Partner with sales through the RFP process. Acting as a key expert and consultant to optimally position CareFirst and our value to specific market opportunities.


3. Financial/Revenue evaluation

  • Work closely with our PBM partner, UW and finance to develop detailed, multi-year strategies that maximize all key financial levers that protect CareFirst’s financial position specific to rebates and reseller spread.
  • Partner across the Specialty Business Unit and the Pharmacy team specifically to identify new and innovative ways to turn Pharmacy into a revenue and value driver for CareFirst.


4. Leadership and Management

  • Leads a team of high level multi-functional subject matter experts, coordinating the account specific strategy required to effectively gain or retain large accounts. 
  • Ensures that Pharmacy Business Consultants represent the Specialty Business Unit in a manner consistent with CareFirst’s overall mission, philosophy and high ethical requirements.
  • Provides leadership for the management of activities, training, development, coaching and feedback required for team members, as well as evaluation and performance management of these associates. 
  • Personnel and performance management
  • Multi-million-dollar Account, Budget and expense management
  • Represents the organization at industry speaking engagements and community events
  • Develops an overall framework, strategy, and standard tools needed for the team’s success. This includes the matrix management of all represented areas and stakeholders to produce the most effective and highest quality materials and provides assessment on the team member’s performance as designated in their performance agreement. Evaluate team skills periodically to maintain highly skilled personnel. Identify and follow through with individual member performance management and training needs.

QUALIFICATION REQUIREMENTS:

Required Education/Experience/Skills/Abilities:

Education

  • Bachelor’s Degree in Business, Accounting, Finance or related field or equivalent professional experience is required. 
  • Master’s degree preferred.

Experience

  • Minimum of 5+ years of progressive management or leadership experience preferably within a health care setting. Within those 5+ years - a minimum of 3 years of extensive consultative experience with demonstrated ability to influence C-Suite, senior staff, and diverse employee populations. 
  • A true subject matter expert with a proven record of generating additional contracts.  Skilled at driving market value for the company by developing relationships with outside partners such as key provider groups and large brokerage houses.
  • This position requires a minimum of ten (10) years of progressively responsible group underwriting experience, including both indemnity and managed care products and a minimum of 5 years of prior supervisory, management or related experience leading teams or projects is required.  Individual must be extremely knowledgeable of risk evaluation and pricing, and rating methodologies used within the health insurance industry, with an in-depth knowledge of self-funding, Pharmacy and stop loss offerings
  • Must have a working knowledge of systems, pricing methodologies, cost reimbursement mechanisms and proposal development.
  • A thorough knowledge of sales processes, healthcare products, multi-distribution channel management, electronic commerce, sales force automation as well as an in depth understanding of consumer and account level service delivery.
  • Must have demonstrated techniques in achieving exemplary client service levels, excellent oral and written communication skills, keen problem solving and decision-making skills.

Skills and Abilities

  • Exceptional presentation skills including the ability to make persuasive presentations, exciting the customer with an enthusiastic presentation style, and the ability to demonstrate values by actively promoting products and services that are of value.
  • Technical Competence; knowledge of technology as it relates to the sales process.  Has ability to understand complex information clients require, and the technical prowess to seek, generate, or cultivate the information required by our customers to aid in the sales process. 
  • Commitment to Building Customer Relationships, with the ability to demonstrate appropriate knowledge of company clients and customers and their needs and requirements; is continuously alert and responsive to changing customer needs, and formulates business strategies designed to enhance customer satisfaction, build relationships and product/service loyalty. 
  • Exceptional interpersonal skills; ability to work with people at all levels of the organization horizontally and vertically and motivate people to act.
  • Strong planning, analytical, problem solving and decision-making skills with the ability to work and make decisions independently and in a team environment.
  • Ability to apply principles and practices to difficult problems on a company wide scale.
  • Ability to direct the activities of very diverse unrelated functions.
  • Exceptional skills in managing people to achieve results by giving solid direction and providing ongoing feedback.
  • Extensive knowledge of sales products and processes at the strategic and tactical levels.
  • Technical Skills
  • Extensive knowledge of health care products, product implementation processes, information systems and planning.
  • Extensive knowledge of various PC and hand-held applications with the ability to convert such applications into effective business tools.


Must demonstrate resilience and effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time.  Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.   Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.


 

Department

Department: Specialty & Pharmacy Administration

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Closing Date

Please apply before: 10/12/2019

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:
The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights of up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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