Director – Networks and Underwriting

🔥 23 hours ago

🇺🇸 United States – Remote

⏰ Full Time

🔴 Lead

📋 Underwriter

👻 Ghost score 13%

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TrueScripts Management Services

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2014

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

TrueScripts Management Services is dedicated to providing exceptional prescription benefit management services. With a focus on delivering maximum savings and amazing care, TrueScripts works closely with members, clients, brokers, and prescribers to offer personalized and customized solutions. The company prides itself on transparency and efficiency, featuring a 24-48 hour turnaround time for prior authorization requests and a commitment to customer service, ensuring that real people are available to assist over 99% of the time.

📋 Description

• Lead TrueScripts’ pharmacy network strategy, performance management, contracting strategy, and network optimization • Evaluate network options and determine appropriate network structures for client populations and market segments • Establish network performance objectives and monitor network economics, access, competitiveness, and client impact • Analyze pharmacy reimbursement trends, market dynamics, competitive positioning, and pharmacy economics • Oversee the development and enhancement of PBM underwriting methodology • Oversee financial modeling for new business, renewals, and existing client opportunities • Establish assumptions for pharmacy utilization, drug mix, reimbursement, discounts, rebates, dispensing fees, trends, and other financial variables • Evaluate financial risk, margin opportunity, pricing recommendations, and underwriting assumptions • Oversee contractual guarantees related to network discounts, ingredient cost, rebates, trend, pricing, and other PBM commitments • Monitor guarantee performance and recommend corrective actions for variances • Support new business and renewal opportunities, RFPs, proposals, negotiations, and deal structure decisions • Provide strategic direction on pharmacy reimbursement, contracting approaches, acquisition costs, MAC pricing, ingredient costs, and dispensing fees • Develop dashboards, reporting, KPIs, executive-level analyses, and actionable recommendations • Partner cross-functionally with Finance, Sales, Client Services, Clinical, Operations, Data & Analytics, and Executive Leadership • Lead, develop, and coach Network and Underwriting team members • Establish goals, accountability, succession plans, standardized processes, and documentation

🎯 Requirements

• Bachelor’s degree in Accounting, Finance, Business, Healthcare Administration, Compliance, or related degree in Business, Finance, Economics, Healthcare Administration, Pharmacy, or related field • 7+ years of progressive experience in PBM, pharmacy benefits, healthcare, underwriting, network management, pricing, or related areas • Demonstrated experience with PBM financial modeling and underwriting • Strong understanding of pharmacy network economics and reimbursement methodologies • Experience with PBM pricing, guarantees, rebates, discounts, and financial commitments • Strong analytical and financial modeling skills • Demonstrated experience leading cross-functional initiatives and influencing executive-level decisions • Strong understanding of pharmacy claims and utilization data • Excellent communication, negotiation, and presentation skills • Primarily remote position with occasional travel to the TrueScripts office in Washington, Indiana • Less than 10% travel required

🏖️ Benefits

• A wide range of health insurance options including medical, dental and vision • A strong salary and bonus program • A robust 401k and company match • ESOP participation with annual allocation of company stock shares • A flexible work environment • A 5-star wellness program including financial incentives, chiropractic and massage services, and fitness stipends • Dream Manager Program • A cohesive, family-based culture • Charitable contributions and volunteer time