Senior Manager – Drug Trend Management Pipeline Development

🔥 12 hours ago

🇺🇸 United States – Remote

💵 $110k - $172k / year

⏰ Full Time

🟠 Senior

👔 Manager

👻 Ghost score 0%

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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 to determine whether patterns are real or data artifacts, populations are correctly defined, spend is real, and existing controls or initiatives already address the issue • Assemble clinical rationales using labeling, compendia, guidelines, comparative efficacy, safety, and member-impact considerations • Develop financial characterizations and build credible clinical and financial cases • Characterize opportunities, form hypotheses, identify the appropriate intervention lever, and make the case to the function that owns it • Identify whether opportunities require utilization management criteria changes, policy updates, claims edits, coordination with PBM or network partners, or SIU referrals • Flag dual- or multiple-natured opportunities and tailor inputs for utilization management, payment integrity, or SIU stakeholders • Feed false positives, near-misses, and nonproductive pattern types back into the detection process • Track why opportunities are discontinued to improve detection capabilities and prevent repeated work • Gradually take on more responsibility for producing and prioritizing opportunities as judgment and detection feedback mature • 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 them • 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 ranges rather than false precision • 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