Senior Manager – Drug Trend Management Pipeline Development

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $110k - $172k / year

⏰ Full Time

🟠 Senior

👔 Manager

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Devoted Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2017

🏥 Healthcare

⚕️ Healthcare Insurance

🧘 Wellness

Healthcare • Healthcare Insurance • Wellness

Devoted Health is a healthcare company that offers Medicare Advantage plans designed to provide comprehensive health coverage with added benefits like dental, eyewear, gym memberships, and prescription drugs at competitive rates. The company emphasizes member support and service, ensuring that clients can easily navigate their benefits and access needed healthcare services. Devoted Health is committed to helping customers save money and enhance their health and wellness through a complete package of benefits and support.

📋 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

🎯 Requirements

• 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

🏖️ Benefits

• 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