Senior Manager – Drug Trend Management Pipeline Development

🕒 il y a 1 mois

🇺🇸 États-Unis – Télétravail

💵 $110 000 - $172 000 / an

⏰ Temps Plein

🟠 Senior

👔 Manager

👻 Score fantôme 5%

Ce que ça veut dire : la probabilité que cette offre reste ouverte sans recrutement actif.Comment le lire : 60 % ou plus, on pense que c'est une offre fantôme. Un score plus bas est moins inquiétant.Comment on la calcule : ancienneté, republications, postes ouverts vs taille de l'équipe, rapidité de clôture, et si le salaire est indiqué.À noter : une estimation à partir de données publiques, pas un jugement sur l'entreprise. De vraies offres peuvent avoir un score élevé, alors prenez-le comme un indice, pas comme un fait.

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Devoted Health

Site WebLinkedInTous les Emplois

1001 - 5000 employés

Fondée en 2017

🏥 Santé

⚕️ Assurance santé

🧘 Bien-être

Healthcare • Healthcare Insurance • Wellness

Devoted Health est une entreprise de santé qui propose des plans Medicare Advantage conçus pour offrir une couverture sanitaire complète avec des avantages supplémentaires tels que les soins dentaires, les lunettes, les abonnements à la salle de gym, et les médicaments sur ordonnance à des tarifs compétitifs. L'entreprise met l'accent sur le soutien et le service aux membres, garantissant que les clients peuvent facilement naviguer dans leurs prestations et accéder aux services de santé nécessaires. Devoted Health s'engage à aider ses clients à économiser de l'argent et à améliorer leur santé et leur bien-être grâce à un ensemble complet d'avantages et de soutiens.

Description

• 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

🎯 Exigences

• 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

🏖️ Avantages

• 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