Job Description
Your Role
The Trade Relations team is responsible for managing the trade relations function of the company in accordance with the policies and practices of Blue Shield of California. The Trade Relations, Principal will report to the Senior Director of Trade Relations. In this role you will work with internal trade partners and clients to support BSC's Pharmacy Care Reimagined initiative in providing members with convenient, transparent access to medications while lowering costs.
Your Work
In this role, you will:
• Develop, analyze and monitor prescription drug, medical claims, and program data to identify opportunities to improve quality and cost of healthcare and to monitor/report performance and outcomes
• Develop project proposals for identified opportunities and support implementation
• Serve as a Blue Shield of California contact and subject matter expert to stakeholders, and manage external relationships (vendors, manufacturers, clients) related to assigned work
• Develop and manage overall contracting strategy (negotiation, review, and execution of contracts) for all lines of business
• Develop alternative payment model (e.g. value-based and outcomes-based contracts)
• Manage medical rebate contracts
• Monitor the impact of preferred drug list on existing negotiations and forecast future contract strategies
• Analyze the impact of client formulary choices with respect to rebate impact; provide rebate status information to clients as requested
• Collaborate with internal partners on contract impact, and provide timely coordination for Pharmacy and Therapeutics review of formularies, posting, and eventual confirmation to the drug manufacturer
• Responsible for timely and accurate maintenance of intricate data sets used for client rebate packages, billing sheets, and any additional supporting documentation
• Understand and negotiate adjusted rebate minimum guarantee
Qualifications
Your Knowledge and Experience
• Requires a Doctor of Pharmacy (PharmD) degree with an MBA or strong business background
• Minimum of 5 years experience in pharmaceutical manufacturer contracting capacity
• A knowledgeable individual with appropriate industry experience, preferable in the healthcare, insurance, or PBM industry
• Medicare Part D, Commercial Full Insured, and ASO knowledge required
• Strong data analysis and presentation skills (pharmacy claim analysis and financial reporting knowledge preferred)
• Project management experience preferred
• A well-organized individual with ability to independently identify, research and resolve issues
• An articulate individual who can relate to people at all levels of an organization and possesses excellent communication skills
• An individual who possesses a strategic focus as well as an operation, implementation, and detailed oriented perspective
• Ability to work with peers in a team effort
• Demonstrated ability to manage multiple priorities and deadline
• Proficient in Microsoft Office and industry related software programs
Pay Range:
The pay range for this role is: $145,970.00 to $218,900.00 for California.
Note:
Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.
About the Team
Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.
Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California's top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!
Our Values:
• Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human. We strive to be our authentic selves, listening and communicating ef
Location: San Diego, CA
Posted: Oct. 23, 2024, 9:02 a.m.
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