Pharmacy Management Consultant (Cmh Health)

Job Details

Who We Are

Independent for 75 years, Milliman delivers market-leading services and solutions to clients worldwide. Today, we are helping companies take on some of the world’s most critical and complex issues, including retirement funding and healthcare financing, risk management and regulatory compliance, data analytics and business transformation.

The health practice is a high-performing environment with multiple subject matter experts, who work together to solve complex problems related to pharmacy benefits, reimbursement, supply, and strategy.

The Pharmacy Management Consultant will lead our payer client pharmacy benefit manager audit services be developing and delivering innovative, market-leading strategies that will encompass various markets and pharmacy stakeholders while being able to learn from other subject matter experts within the cross-functional team.

Job Responsibilities

• Use pharmacy clinical and financial knowledge to diagnose and solve payer client problems.
• Manage small to large payer client relationships within large matrix organizations
• Design and deliver pharmacy benefit manager audit support to payer clients by developing proposals, creating presentations, and delivering innovative, market-leading recommendations to clients.
• Manage a team of pharmacy benefit analysts, managed care pharmacists, data scientists, healthcare data analysts, and / or actuaries to successfully plan, manage, monitor, and execute pharmacy benefit audits on behalf of payer clients.
• Potential travel may be required, either onsite at vendor’s location to conduct the audit and/or an onsite client presentation audit results.
• Ability to engage in and contribute to strategic discussions with executive c-suite level leadership for payers in the pharmacy benefits industry
• Create new and expand upon existing consulting relationships with health plans, employers, and coalitions / cooperatives.
• Serve as a subject matter expert of pharmacy benefit claims adjudication, pricing and performance guarantees, utilization management program / edits, and rebate contracting for payer clients.
• Create and execute a marketing strategy to grow CMH Health’s pharmacy benefit audit services.

Potential projects could include:

• Analyzing pharmacy data and audit findings to provide solutions for cost-containment, including formulary optimization strategies
• Commercial, Medicare Part D, and/or Medicaid PBM audits
• Milliman Health Cost Guideline Pharmacy Research
• Evaluation of pharmaceutical pipeline and development of a cost management strategy (e.g., evaluating impact of drugs seeking regulatory approval for non-alcoholic steatohepatitis, oncology, heart failure, etc.)
• Strategic support to plan and execute multi-year audit plans with complex organizations
• Pharmaceutical manufacturer product strategy (e.g., analytics to support the impact of regulatory changes on the current reimbursement environment)

Minimum requirements

• Advanced proficiency using Microsoft Excel
• 7+ years of pharmacy benefit audit experience
• Doctorate of Pharmacy (pharmacist only), Master of Business Administration, Master of Public Health, or other relevant degree preferred

Competencies and Behaviors that Support Success in this Role

• Ability to work collaboratively with remote employees.
• Deep understanding of auditing pharmacy benefits, including claim adjudication, discounts and dispensing fee guarantees, manufacturer rebate contract reviews, and utilization management program rules, and performance guarantees.
• Detail oriented with superior organizational skills.
• Experience working with large pharmacy claims data sets.
• Experience auditing manufacturer rebate contracts.
• Strong sense of accountability and business acumen.
• Strong verbal and written communication skills.
• Experience solving complex problems with innovative, creative solutions.
• Experience working with commercial, Medicare, and /or Medicaid payers.
• 7+ years working experience, preferably at a consulting firm, PBM, managed care organization, health plan, employer, or coalition / cooperative company.

The Team

Milliman is one of the leading experts in healthcare financing and delivery. We advise clients on a wide range of issues—from assessing the impact of healthcare reform on organizations or populations to streamlining operations while advancing the quality of patient care. Our consulting work is supported by a powerful toolkit of data analytics solutions and informed by the most trusted, comprehensive set of cost guidelines in the industry.

Through a team of professionals ranging from actuaries to clinicians, technology specialists to plan administrators, we offer unparalleled expertise in employee benefits, investment consulting, healthcare, life insurance and financial services, and property and casualty insurance.

Salary: The salary range is $105,000 to $175,000, depending on relevant factors, including but not limited to education, work experience, certifications, location, etc.

Location: It is preferred that this candidate work in-office at the Milwaukee, Chicago, or Harford office. Remote candidates will be considered.

Benefits

At Milliman, we focus on creating an environment that recognizes – and meets – the personal and professional needs of the individual and their family. We offer competitive benefits which include the following based on plan eligibility:

• A minimum of 8 paid holidays
• Medical, dental and vision coverage for employees and their dependents, including domestic partners
• A discretionary bonus program
• Milliman covers 100% of the premiums for life insurance, AD&D, and both short-term and long-term disability coverage
• Flexible spending accounts allow employees to set aside pre-tax dollars to pay for dependent care, transportation, and applicable medical needs
• Paid Time Off (PTO) starts accruing on the first day of work and can be used for any reason; full-time employees will accrue 15 days of PTO per year, and employees working less than a full-time schedule will accrue PTO at a prorated amount based on hours worked
• Family building benefits, including adoption and fertility assistance and paid parental leave up to 12 weeks for employees who have worked for Milliman for at least 12 months and have worked at least 1,250 hours in the preceding 12-month period
• A 401(k) plan with matching program, and profit sharing contribution
• Employee Assistance Program (EAP)

All qualified applicants will receive consideration for employment, without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)