Sr Director Network Contracting- Genoa Healtcare- Renton, WA
- East Hill-Meridian, WA
A career with Genoa Healthcare means you are part of a collaborative effort to serve behavioral health and addiction treatment communities. We do more than just provide medicine: we change lives for the better. People with serious mental or chronic illness - and those who care for them - have moving stories, and at Genoa, we become their voice, their partner. Working as part of a coordinated care team, we partner with community-based providers and others to ensure that people with complex health conditions get the right medications and are able to follow their treatment plans. Our personalized services - in-clinic pharmacies, telepsychiatry and medication management - are leading the way to a new level of care.
We recently joined OptumRx, a pharmacy care services company that is part of Optum and UnitedHealth Group's family of businesses. We are part of a leading information and technology-enabled health services business dedicated to making the health system work better for everyone. Take a closer look to learn why a career with Genoa Healthcare might be the path to discovering your life's best work. SM
Reporting to the Senior Vice President, Procurement & Network Management, this position provides oversight and management for pharmacy and medical claims contracting, network management and performance measurement, pharmacy licensing and payer audit activities for all lines of business nationally at Genoa. Reporting to this role will be the contracting and network management functions for both pharmacy and medical claims, pharmacy licensing and audit personnel and supporting data analysts. In addition, this person will assist in building out the organizational design to support the rapid growth of our business.
Key responsibilities of this position include:
- Manage relationships with PBMs and payers to ensure pharmacy and medical contracts and networks are effective and up to date to support the national network of Genoa pharmacies.
- Support and contribute to the overall payer contracting strategy and execution including negotiations, contract management, and profitability targets.
- Monitor and analyze performance of third party payer agreements including profitability, volume, strategic initiatives and contract compliance.
- Lead contract review projects, complete thorough reviews of existing contracts and provide executive summary reports outlining opportunities for improvement.
- Educate payers and develop the company's brand and identity to support the mission of a growing, customer-focused company.
- Keep abreast of state and federal government legislation as well as market dynamics to anticipate industry and payer trends.
- Provide leadership and develop strategy for the pharmacy licensing and contracting department. This team is responsible for management of all pharmacy license applications, including state Board of Pharmacy, Drug Enforcement Agency, business licensing, network contracting, and other regulatory stakeholders.
- Oversee the payer audits team, establish best in class performance standards and implement processes to achieve targets.
- Enhance and broaden the company's medical contracting capabilities to generate additional business opportunities.
- Collaborate with operations leadership to establish and execute contracting initiatives and objectives, identifying and prioritizing areas of focus.
- 5 years in pharmacy benefit management or pharmacy experience in a health plan, with a strong understanding of the PBM contracting process and prior negotiation of PBM contracts.
- Experience in pharmacy licensing and familiarity with payer audits process preferred
- 3-5 years managerial experience building and leading teams
- Strong verbal and written communication skills including presentation skills and payer/PBM relationship management experience at an executive level
- Strong financial analysis, problem-solving, organization, critical thinking, and time management skills
- Proficiency with Microsoft Excel, Word, Outlook, and PowerPoint
- Highly developed relationship-building skills to foster effective working relationships across Genoa.
- Undergraduate degree is required.
- Advanced degree or MBA is highly desirable.
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