Overview
The Director of Specialty Pricing is responsible for Specialty pricing strategy as well as the execution, implementation, and optimization of current, new, and future pricing innovations. Will lead complex financial modeling and process development to create business insight, quality assurance, and execution to achieve departmental goals.
In partnership with other team leaders and members, develop reimbursement strategy, execute on pricing, and oversee pharmacy and client analytics including activities that fall under the Specialty PBM umbrella. Assist with negotiation and contract strategy, and coordination with Operations on implementation of various network / pricing strategies.
Develop capabilities specifically targeted to achieve the efficient and effective application of the company’s go-to-market strategies, integration with outside vendors, and services toward the achievement of total cost savings and improved health outcomes for the company’s clients and their members.
Why Maxor?
Pharmacies are essential to healthcare, with nearly 90% of the US population living within 5 miles of one and seeing their pharmacist an average of 12 times a year. Providing a positive patient experience is crucial to ensuring patients adhere to their therapies. At Maxor, we recognize that our employees are our most valuable assets. We actively seek and retain talented professionals who are mission-driven to improve healthcare outcomes for patients. Our employees are essential to their own well-being, finding fulfillment in meaningful work, competitive compensation, diverse and inclusive teams, and limitless career possibilities. With a workforce of 1,000+ and almost a century of pharmacy experience, we offer the stability of a Fortune 500 company and the energy and innovation of a startup. Our expertise and technology support the entire pharmacy ecosystem, but our impact goes beyond pharmacy services. We enable pharmacy care.
Our Company
Founded in 1926, Maxor is a leading, independent pharmacy solutions platform that improves prescription drug affordability and outcomes. Over time, Maxor has built a unique and complementary suite of services and technology offerings that deliver clinical, financial and strategic value to patients, payors and providers across the pharmacy supply chain. Maxor has a proud heritage of growth and innovation earned over the decades. Amarillo, Texas is the legacy headquarters for Maxor, but our talent base is national. We operate pharmacies and other business operation sites across the United States with more than 1200 employees working from 42 states
Position Location
This is a remote-based position within the Continental US.
Responsibilities
- Support the PBM and Specialty departments.
- Develop business, industry, competitive, client, and technical knowledge to formulate pricing strategy, and to execute financial modeling of comprehensive pricing strategies.
- Maintains the integrity of networks to ensure that negotiated contracts comply with Company policies and contractual and regulatory requirements; develops and maintains solid relationships with key Specialty stakeholders to ensure collaborative network contracting and
- Develops and manages PBM positioning in the marketplace; negotiates and manages performance-based contracts; balances the financial, operational and regulatory impact of contracting when developing and/or negotiating contract
- Analyzes pharmacy performance and evaluates performance against contractual requirements; evaluates client contract performance to identify potential cost savings opportunities.
- Evaluates and maintains implementation and adjudication table in accordance with established strategy, reimbursement structures, and other key processes; assesses market rates and pharmacy performance to establish rates and negotiation strategies; develops and implements innovative pharmacy network contracting engagement strategies to support the provision of value added
- Develops and implements contracting strategies to support new programs, third party vendors, and address market dynamics; communicates proposed contractual terms with internal stakeholders and negotiates mutually acceptable
- Collaborates with cross-functional teams in pricing development and contracting, including strategy, rate structure, and contract requirements; communicates the Company’s direction and strategy internally and to clients.
- Demonstrates a thorough understanding of contract policies, language, and terms of agreement to ensure compliance and consistency in contracting and that financial/operational impact and legal implications are aligned with business objectives; supports Company in audits and appeals.
- Monitors external information for competitive intelligence purposes including rates, market share, and products; anticipates future competitor, client, and industry environments and develops programs that appropriately position MaxorPlus.
- Stays abreast of changes and/or updates in relevant policies, procedures, regulations, and legislative trends to train and educate internal
- Monitor outcomes and manage network performance; creates standard performance reports, and communicates performance to internal and external
- Consult with internal leaders and departments to coordinate relevant cross functional activities in support of performance management efforts to maximize the organization’s competitive position.
- Collaborate with the Underwriting team to provide recommendations on pricing / networks offerings and negotiation strategy to achieve revenue, profitability targets, and margin retention, for new and existing customers.
- Execute and implement dynamic pricing strategies in response to market fluctuations to provide competitive, profitable, and best of class pricing offers.
- Support Underwriting in Network population data requirements for new business proposals.
- Support cross functional analyses across Pharmacy Services, Rebate, and Underwriting departments to develop and implement business solutions that have a broad impact on the organization’s operations and processes.
- Manage client contracts guarantees to ensure accuracy and eliminate liability payments to clients.
- Provide consultative services to internal support teams for processes improvements.
- Proactive identification and closure of network gaps as well as development of performance reports.
- Design plans that align with the contract strategy for MaxorPlus and Maxor Specialty and communicate this strategy to Senior Leadership.
- Conduct contract negotiations and renewals, including assessment of market trends and competitive positions relative to rate.
- Assure that all contracts follow network governance process and structure.
- Develop and support Specialty strategies to improve client and member satisfaction.
- Ensure contracts and amendments are finalized in compliance with corporate policy, and if applicable, state licensure requirements, state mandates, regulatory agencies, and/or federal and CMS regulations.
- Responsible for tracking pricing implementation, oversee creation of reporting and design of specific action plans for implementation that are off-track.
- Exhibiting compliant and ethical behavior in the performance of duties, including complying with all applicable federal and state laws, regulations, and company policies and procedures.
- Promptly report any allegations of impropriety to the Compliance Department.
- Comply with Maxor’s Ethical Business Conduct policy and Maxor’s Compliance Program.
- Remain free from exclusion under the OIG and SAMS Medicare/Medicaid lists.
- Complete required training, as assigned, within the established timeframes.
- Must be able to cope with the mental and emotional stress of the position.
- Maintain regular attendance in accordance with established policies
Qualifications
Education: Bachelor’s Degree
Experience: 5+ years’ experience in Specialty pricing, negotiation, and management. 2+ years’ experience managing direct reports.
Knowledge, Skills, and Abilities:
- Proficient knowledge of the PBM/healthcare industry with demonstrated success in developing and managing Specialty models, networks, and strategy.
- Familiarity with clinical considerations surrounding Specialty drugs, high touch therapies, and disease states.
- Expertise in the various components that influence pricing strategies such as net cost, supply constraints, manufacturer assistance, product optimization, rebates, and third party patient assistance programs.
- Strong internal and external communication, interpersonal, organizational, negotiation, and presentation skills.
- Must be a self-starter and high-performing individual with the ability to interact and engage with internal and external stakeholders at all levels, manage expectations, and effectively interface with clients, cross-functional teams, and senior management.
- Must have extensive experience working with complex data sets and strong skills with Microsoft Office (Excel, Word, PowerPoint). Familiarity with SQL or data visualization software is a plus.
- Ability to organize and manage multiple priority tasks simultaneously.
- Proven and demonstrated project management skills, directing project activities to a cross-functional team.
- Problem solving ability in unstructured situations.
- Ability to lead effective meetings, accomplish goals and meet timelines.
- Ability to manage, mentor, and develop team members with expertise on all aspects of Specialty pricing with particular emphasis on developing processes that are both accurate and efficient.
- Experience influencing change and adoption of new capabilities to support pricing and financials.
- Will represent MaxorPlus on cross-functional projects, initiatives, or consulting opportunities.
WHY MAXOR?
Did you know that patients see their pharmacist an average of 12 times a year? Pharmacy is at the heart of healthcare. Come join Maxor and make a direct impact on patients’ lives. Improve your own wellbeing with our robust benefits and flexible work environment. At Maxor, you have a career with limitless possibilities and the charge to make a difference. A company of 1,000 diverse people and almost 100 years of pharmacy experience, we offer the stability of a Fortune 500 company with the energy and innovation of a startup. We provide services and technology that fuel the entire pharmacy ecosystem, but we are more than pharmacy services. We enable pharmacy care.
WE OFFER: A diverse, progressive culture that supports a work from home model, a “dress for your day” attire when working onsite, and a collaborative, team oriented environment. Our industry leading compensation and health benefits include:
- Comprehensive mental health and wellbeing resources
- Nationwide Blue Cross Blue Shield PPO with employee friendly plan design, including $850 individual annual medical deductible, $25 office visit copays, Low biweekly premiums
- Company paid basic life/AD&D, Short-term and Long-term disability insurance
- Rx, dental, vision, short-term disability, and FSA
- Employer-matched 401k Plan
- Industry leading PTO plan
- And MORE!
Maxor is an EOE, including disability/vets
Please apply online at: https://careers-maxor.icims.com/
