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Sr Advisor, Centene/WellCare Pharmacy Reconciliation & Strat

CVS Health

This is a Full-time position in Scottsdale, AZ posted June 10, 2021.

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| Sr Advisor, Centene/WellCare Pharmacy Reconciliation & Strategy in Scottsdale, AZ US | CVS HEALTH
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Home Sr Advisor, Centene/WellCare Pharmacy Reconciliation & Strategy
Sr Advisor, Centene/WellCare Pharmacy Reconciliation & Strategy
Apply Now Job Title: Sr Advisor, Centene/WellCare Pharmacy Reconciliation & Strategy Job ID: 1614576BR Location: AZ
– Scottsdale Street Address: 9501 E Shea Blvd Category: Network and Provider Management Job Description
Exciting new position at CVS Health, a Fortune 5 Company.

The Senior Advisor will join our Pharmacy Benefits Team (PBM) in a client facing role supporting a specific client and providers.

The position will develop, implement and manage the infrastructure and framework to support Centene/WellCare network revenue initiatives.

This position requires strategic scrutiny and direct management of pharmacy contract components including but not limited to BER, GER, dispensing fees, etc.

– to satisfy several PBM objectives (e.g., meet Centene/WellCare client performance guarantees, comply with legislation, achieve financial goals, etc.).

This level of exposure and managing to approx.

$100M+ in pharmacy disputes and reconciliation requires emphasis in experience, skillset, industry knowledge and existing external peer relationships in order to reconcile financial targets while maintaining these critical key provider relationships in the market place.
You will have responsibility that directly supports Centene/WellCare in Network Services and pharmacy providers on behalf of Pharmacy Benefits Managment.

You will develop strategies to mitigate and eliminate pharmacy and client over and under performance.

This position is critical to providing and managing revenue and reconciliation solutions for client financial targets and pharmacy contractual guarantees.
The incumbent will be responsible to review, analyze and interpret all available information to ensure pharmacy network strategies are properly positioned to meet Centene/WellCare, Caremark and pharmacy contractual guarantees.

In this role you will:
1.

Define, execute and standardize provider-facing monthly reporting on an ongoing basis to ensure accuracy to achieve minimum disruptions and reduce disputes at the annual reconciliation.

2.

Complete periodic reporting, reconciliation and settelment with retail chains/PSAOs to ensure client, PBM and enterprise financial objectives are satisfied..
3.

Troubleshoots and employs new methods to improve network development initiatives to help Centene/WellCare optimize network performance, obtain higher retention levels using network and industry information to leverage as needed for successful outcomes.
4.

Develop new processes and reports to maximize corporate enterprise assets to achieve the highest pharmacy performance standards in the most cost-effective manner; leverage this information to assist internal/external partners to ensure appropriate client guarantees are achieved.
Required Qualifications

– 5 years experience negotiator with industry knowledge and long-term relationships with main external audiences (retail pharmacy, mail order, specialty, PBM and ancillary stakeholders)

– 5 years experince as strategist in pharmacy BER/GER/OED terms to meet or exceed expected outcomes regarding client expectations, enterprise value and PBM financial revenue goals

– Comprehensive understanding of clients, pharmacy providers, PBM and enterprise financial goals and necessary throttling to achieve specific goals
-5 years experiene with competitive factors in the market place (e.g., MAC pricing/establishing and understanding provider contracting strategies) and current demands that can affect negotiation outcomes with select providers

– Experience organizing and managing multiple projects/tasks concurrently

– 7 years experience problem-solving skills and analytics ; expert knowledge of PBM financials

– Comprehensive knowledge of PBM operations; retail, mail, specialty pharmacy
Preferred Qualifications
5 years modeling financial outcomes experience
5 years experience developing tracking tools and dashboards
5 years project management experience
Retail pharmacy knowledge/experience highly desirable
Education
Bachelor’s Degree
Business Overview
At CVS Health, we are joined in a common purpose: helping people on their path to better health.

We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused.

Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We strive to promote and sustain a culture of diversity, inclusion and belonging every day.

CVS Health is an equal opportunity and affirmative action employer.

We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law.

We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

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We are committed to a workplace that supports diversity, inclusion and belonging.

CVS Health is an equal opportunity and affirmative action employer.

We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law.

We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT.

Please note that we only accept applications for employment via this site.

We provide reasonable accommodations to individuals with disabilities.

To request an accommodation, including a qualified interpreter, written information in other formats, translation or other services, please email AdviceandCounsel@cvshealth.com or call 877-805-9511.If technical issues are preventing you from applying to a position, contact Kenexa Helpdesk at 1-855-338-5609 or cvshealthsupport@us.ibm.com . For technical issues with the Virtual Job Tryout, contact the Modern Hire Help Desk at 1-877-451-1695 or cvs_support@modernhire.com .The health and safety of our employees, patients, customers, and members is our top priority as we face the impact of COVID-19 together.

We encourage you to visit our COVID-19 resource center at https://cvshealth.com/covid-19  to learn more. Please be aware that CVS Health does not will never solicit money or offer payment for job applications, nor do we ask candidates to email or submit any personal information over unsecured channels.

To learn more, please visit https://jobs.cvshealth.com/FAQ .

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About CVS Health

At CVS Health, we are joined in a common purpose: helping people on their path to better health.

We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused.

Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are an equal opportunity and affirmative action employer.

We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status.

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