Senior Manager – Drug Trend Management Pipeline Development

🔥 20 horas atrás

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $110.000 - $172.000 / ano

⏰ Tempo Integral

🟠 Sênior

👔 Gerente

👻 Score fantasma 0%

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Devoted Health

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 2017

🏥 Saúde

⚕️ Seguro de Saúde

🧘 Bem-estar

Healthcare • Healthcare Insurance • Wellness

A Devoted Health é uma empresa de saúde que oferece planos Medicare Advantage projetados para fornecer cobertura de saúde abrangente com benefícios adicionais como cuidados dentários, óculos, associações a academias e medicamentos prescritos a preços competitivos. A empresa enfatiza o suporte e serviço ao membro, garantindo que os clientes possam navegar facilmente por seus benefícios e acessar os serviços de saúde necessários. A Devoted Health está comprometida em ajudar os clientes a economizar dinheiro e melhorar sua saúde e bem-estar por meio de um pacote completo de benefícios e suporte.

Descrição

• Evaluate surfaced drug cost, safety, and integrity opportunities across Part B and Part D • Pressure-test signals, populations, spend, existing controls, and work already in flight • Assemble clinical rationales using labeling, compendia, guidelines, comparative efficacy, safety, and member-impact considerations • Characterize and size the financial opportunity • Form hypotheses about the problem and identify the appropriate lever or owner • Present evidence-based cases to utilization management, payment integrity, SIU, policy, PBM, network, and other stakeholders • Flag dual- or multiple-natured opportunities and identify what each function needs • Feed false positives, near-misses, and unsuccessful pattern types back into detection processes • Track why opportunities are abandoned to prevent duplicated work • Gradually take on more responsibility for producing and prioritizing opportunities as detection capabilities improve • Report to the Director, Clinical Pharmacy

🎯 Requisitos

• Deep expertise and immersion in the pharmacy domain, with a proven ability to apply this knowledge to drug cost, safety, and integrity opportunities • At least 5-8 years of experience in managed care pharmacy, utilization management, drug trend, or program integrity, with meaningful Part B and Part D exposure • Population-level analytical instinct; ability to reason about cohorts and trends across many members • Medicare regulatory fluency, including protected classes, negative formulary change rules and CMS submission timing, transition fill, the Part B versus Part D coverage boundary, and appeals implications • Hands-on experience with pharmacy claims data (NCPDP, GPI, DAW, NDC) and medical claims data (HCPCS, buy-and-bill, units billed versus administered) • Strong written and verbal communication skills • Breadth across payment integrity, data science, actuarial, and investigation functions • Evidence of lifelong learning, such as building a query library, automating manual work, or learning an unassigned tool • Experience improving processes from inside the work • Experience building or working alongside detection, suspecting, or FWA models • Pragmatic view of agentic or LLM-assisted tooling • Familiarity with payment integrity, SIU, or actuarial workflows • Rigor with data, including open versus closed periods, shifting denominators, and range-based analysis • Understanding of matrix organizational patterns within a health plan, MA-PD plan sponsor, or PBM setting • Deep domain expertise in drug trend management and pharmacy operations • Clinical credentials such as a PharmD are valued but not required

🏖️ Benefícios

• Employer sponsored health, dental and vision plan with low or no premium • Generous paid time off • $100 monthly mobile or internet stipend • Stock options for all employees • Bonus eligibility for all roles excluding Director and above • Parental leave program • 401K program