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Anthem, Inc. Staff VP PBM Contract Oversight Management in Middletown, New York

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health care companies and a Fortune Top 50 Company.

Seasoned, skilled leader responsible for the lifecycle of contract management in a rapidly growing PBM organization. Able to work in a fast-paced, matrixed environment and have strong working knowledge in the areas of legal, compliance and risk as well as communication and negotiation skills. Primary duties may include, but are not limited to:

  • Administers and oversees governance of key vendor agreements inclusive of outsourced pharmacy benefit management vendor.

  • Develops and maintains PBM agreements with our clients, optimizing terms and conditions.

  • Manages third-party accreditation processes with URAC and NCQA, ensuring we operate in a state of continual readiness.

  • Manages PBM, TPA and UM licensure filing and renewals.

  • Leads multiple audits – Client Audits, NCQA & URAC accreditation audits, in addition to state utilization management audits, and the annual PBM delegation audit.

  • Establish policies, procedures and framework to manage accountability and contract compliance.

  • Develops, maintains, reports and drives continuous improvement of PBM performance guarantees, both those from our outsourced vendor and those we offer our clients.

  • Provides recommendations in client RFP process related to performance guarantee offerings and coordinates with appropriate stakeholders the implementation of new guarantees.

  • Identifies areas of opportunity to increase efficiency and maximize revenue opportunities and drives improved results based on continuous improvement assessments and flawless execution.

  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.

    Key functional areas:

  • Performs Contract Management, Governance and Oversight

  • Oversees and manages Performance Guarantees

  • Manages Accreditation & Vendor Oversight

  • Coordinates Client Contracting including collaboration with other functional areas

  • Maintains PBM, TPA, and UM Licensure

  • Leads the Process Improvement team for IngenioRx and partners with IngenioRx functional teams on related opportunities

Qualifications

Requirements:

BA/BS in a related field or any combination of education and experience, which would provide an equivalent background

Minimum of 15 years professional experience in managed care or related experience

Minimum of 10 years’ experience within the pharmacy benefit management space

Preferred:

Experience with PBM Accreditation NCQA & URAC

Experience with PBM licensure process

PBM contract negotiations experience

Significant experience presenting to Senior Executives and external constituencies.

Applicable to Colorado Applicants Only

Annual Salary Range*: $151,788- $189,735

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

  • The hourly or salary range is the range Anthem in good faith believes is the range of possible compensation for this role at the time of this posting. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

    We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

    REQNUMBER: PS59076

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