Job Description:

Who We Are:

Managed Health Care Associates, Inc. (MHA) provides care communities access, solutions, and insights to help them run their businesses more effectively. Our members include post-acute providers across the care continuum, including long-term care, home infusion, specialty pharmacies, senior living, and other group living facilities. Our team of associates is passionate about our common mission of helping people age with grace and championing our core values of being Curious Learners, Selfless Advocates, and Relentless Finishers.

At our company, you will join a diverse and talented team of innovators who are passionate about transforming the health care industry. As a valued member of our company, you will enjoy a competitive compensation package, a supportive work environment, and opportunities for professional development.

Who we’re looking for:

We are looking for an amazing executive with leadership experience and expertise of Prescription Benefit Manager (PBM) services in relation to Medicare Part D within Long-Term Care Pharmacies (LTCP). 

What You’ll Be Doing:
The VP, Reimbursement Network Solutions is responsible for developing annual strategic business plans to achieve and exceed network revenue goals through these primary objectives:
1) Managing, engaging, and developing the network operations and network specialist teams
2) Integrating Net-Rx™ (MHA’s suite of reconciliation and reimbursement technology solutions) into member and PBM/Plan value propositions
3) Providing overall network strategic guidance on prospective PBM contracting opportunities in collaboration with LTCP and cross-functional leaders
4) Building synergistic member and partner communication strategy
5) Co-developing a network internal and external dashboard to help manage objectives and goals

The VP will develop and maintain trusted relationships with key business partners, members and internal MHA cross functional teams. The VP will be a primary resource for the MHA member engagement team for training and analysis of MHA negotiated Part D contracts and areas of optimization including: 

• Track the execution of strategic business plans  and communicate successes and opportunities accordingly


• Constantly monitor the competitive landscape and market conditions to identify opportunities, issues, and risks in order to recommend tactical strategies for network value expansion


• Decipher market activities and communicate implications for both MHA and our membership base


• Build effective relationships with PBMs and plans to help with conflict resolution, negotiation, and contract value


• Manage the mid-size and small PBM relationships including contracting, onboarding, and reporting


• Strategically participate in member business review meetings to reinforce MHA value, market position, and industry trends


• Develop the PBM business review meeting standard operating procedure and execution tactics, and actively participate in meetings


• Develop recommendation for a future operational network team based on industry and business shifts for optimal efficiency and performance


• Proactively manage member AR and net revenue P&L and balance sheet objectives


• Develop expert understanding of content details within contracts and MHA agreements, both what is included (and what is not)


• Collaborate cross functionally and business partner to develop product strategies for the LTC marketplace

What You’ll Bring to the Table:

• Bachelor’s degree + MBA or other directly applicable advanced degree preferred


• 12+ years of directly related commercialization, account management, sales, or combinations of such experience


• 7+ years of directly related leadership experience in Pharmaceutical, Healthcare, Insurance Provider or GPO


• Expertise of Prescription Benefit Manager (PBM) services in relationship to Medicare Part D within Long-Term Care Pharmacies or Facilities preferred


• Understanding basic reimbursement mechanisms with Part D, commercial and Medicaid


• Proven ability to influence C-level executives and help direct reports develop industry expertise and drive results


• An excellent reputation of partnering with internal and external constituents, partners and other service providers


• Successful track record managing the achievement of results


• Strategic big-picture thinking with a proven ability to drive step-changes in an emerging business


• Excellent planning, analysis, organization, communication and presentation skills, with the ability to distill complex issues to straightforward concepts


• Strong negotiation, collaboration, teamwork, and partnership skills


• Demonstrated ability to work in a team environment that requires quick turnaround and quality output.

What’s Good to Know:

• Able to travel 35% of the time


• Remote or hybrid environment

Physical Demands:

The physical demands and work environment characteristics described here are representative of those that an employee must meet to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.  The employee must occasionally lift and/or move up to 15 pounds. 


• Mental Demands: the employee must be able to follow directions, to get along with others, and handle stress.


• Work environment:  The noise level in the work environment is usually minimal.

Managed Health Care Associates, Inc. is an Equal Opportunity Employer and ensures its employment decisions comply with principles embodied in Title VII, the Age Discrimination in Employment Act, the Rehabilitation Act of 1973, the Vietnam Veterans Readjustment Assistance Act of 1974, Executive Order 11246, Revised Order Number 4, and applicable state regulations

               

 

 

 

 

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)

Operations

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