Vice President, Pharmacy Networks

🕒 6 dias atrás

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SmithRx

SiteLinkedInTodas as Vagas

51 - 200 funcionários

Fundada em 2018

💼 Consultoria

🛡️ Seguros

🏥 Saúde

💰 $20.000.000 Series B em 2022-03

Consulting • Insurance • Healthcare

A SmithRx é uma gestora de benefícios farmacêuticos transparente e direta, que opera de forma independente de companhias de seguro e farmácias para alinhar seus incentivos com empregadores auto-segurados e seus membros. Ao aproveitar a tecnologia moderna, a SmithRx busca reduzir o custo e a complexidade dos benefícios farmacêuticos, garantindo a entrega de medicamentos eficazes e de baixo custo. A empresa está dedicada a transformar o cenário dos benefícios farmacêuticos através de seu modelo de precificação transparente e de taxa fixa e programas inovadores de economia de custos, que conectam os membros aos medicamentos de menor custo sem o uso de precificação diluída, descontos ou outras táticas. O compromisso da SmithRx com a transparência e um serviço ao cliente superior resulta em economias significativas para empregadores e uma experiência altamente satisfatória para seus membros.

Descrição

• Lead Network Strategy: Design and execute the overarching strategy for SmithRx’s national and custom pharmacy networks, ensuring alignment with our transparent business model and client needs. • Contract Negotiation: Lead high-level negotiations with major retail chains, PSAOs, specialty pharmacies, and mail-order partners to secure competitive reimbursement rates and favorable contract terms without relying on spread pricing. • Identify and develop innovative network programs (e.g., high-performance or narrow networks, direct-to-consumer delivery models) to drive down drug costs and improve member access. • Monitor and manage the ongoing performance of the pharmacy network against defined SLAs, ensuring adherence to contractual terms, quality standards, and pricing accuracy. • Direct the credentialing and re-credentialing processes, ensuring all network pharmacies comply with federal, state, and SmithRx regulatory standards. • Oversee the pharmacy audit team to manage network integrity, minimize Fraud, Waste, and Abuse (FWA), and execute audit recoveries effectively. • Implementation of needed policies and procedures to meet CMS oversight requirements. • Partner closely with Sales, Customer Success, Clinical Strategy, Pricing/Underwriting, and Product teams to ensure network capabilities are accurately represented in the market and successfully integrated into our technology platforms. • Collaborate with data and analytics teams to monitor network profitability, utilization trends, and cost models to proactively identify areas for financial optimization. • Build, mentor, and scale a high-performing team of network managers, contracting specialists, and analysts. Foster a culture of accountability, integrity, and courage.

🎯 Requisitos

• 12+ years of progressive leadership experience in pharmacy network management, pharmacy contracting, or PBM operations. • Experience across lines of business: Commercial, Medicare, Medicaid, Exchange • Deep understanding of the PBM ecosystem, pharmacy reimbursement models (AWP, MAC, NADAC), and the operational differences between traditional and pass-through/transparent PBMs. • Proven track record of successfully negotiating complex, multi-million dollar contracts with major national pharmacy chains and PSAOs. • Demonstrated experience building, leading, and mentoring cross-functional and remote teams in a high-growth environment. • Strong financial and analytical skills with the ability to understand complex pricing models and translate data into actionable network strategies. • Bachelor’s degree in Business, Healthcare Administration, Finance, or a related field; PharmD or Master’s degree (MBA/MHA) is highly preferred.

🏖️ Benefícios

• Highly competitive wellness benefits including Medical, Pharmacy, Dental, Vision, and Life Insurance and AD&D Insurance • Flexible Spending Benefits • 401(k) Retirement Savings Program • Short-term and long-term disability • Discretionary Paid Time Off • Paid Company Holidays • Wellness Benefits • Commuter Benefits • Paid Parental Leave benefits • Employee Assistance Program (EAP) • Well-stocked kitchen in office locations • Professional development and training opportunities