Director Specialty Pharmacy Payer Strategy

Job Overview

Lead the strategy, planning, and execution of cutting-edge payer programs and services that position Fairview Specialty Pharmacy as a market leader in the competitive specialty marketplace. Drive the development of innovative initiatives that enhance our value proposition, ensure payer access, and boost profitability. Oversee business analytics supporting payer strategies that elevate revenue and enhance the patient and client experience. Additionally, provide consultative expertise to internal teams and external partners, including payers (health plans), employers, and health system clients, fostering collaboration and driving transformative solutions.

The pay range for this role is $171,000-$241,758 annual base and is dependent on candidate's amount and type of experience. This role is also eligible to participate in a Managment Incentive program.

Strategy and Execution (35%):

• Involved in the development, implementation, and management of a comprehensive, market-based payer strategy.
• Direct innovative programs, products, and services developed based on market need assessments, to increase Fairview Specialty’s value and ability to successfully compete and win in the market.
• Involved in the planning and successful execution of market-leading payer programs, products, and service offerings to position Fairview Specialty for success in competitive bidding scenarios against national specialty pharmacy organizations.
• Partner with senior leaders to evaluate and recommend specialty pharmacy strategies to M Health service lines to increase revenue and improve market position, while protecting margin.
• Ensure alignment of payer programs with Fairview’s strategic business initiatives.
  
  
  

Analytics and Consultative Services (25%)

• Directs and manages reporting and analytic capabilities for the payer team which supports strategic decision-making and clear differentiation in the market.
• Provides consultative expertise to assist clients with strategy formation, data interpretation, and recommendations for program and/or plan improvements.
• Directs efforts to develop, craft, and promote Fairview Specialty’s “value proposition” to payers, using data and analytics, to ensure specialty pharmacy access.
• Directs and manages enhancements to the Fairview Specialty reporting package to continue to meet and exceed client needs and strengthen market position.
• Collaborates with senior clinical, business, and technical leaders across the M Health organization to p rovide internal consultative services based on experience and expertise related to Total Cost of Care (TCOC) and population health modeling, use and understanding of acuity risk methodology and algorithms, data analytics, and health outcomes research.
  
  
  

Account Management & Sales (20%)

• Account and relationship management of current and new specialty pharmacy payer accounts, resulting in client retention, loyalty, and profitability for the organization.
• Co-leads client meetings to review Fairview Specialty Pharmacy’s programs and performance results using comprehensive reporting tailored to client needs.
• Directs the development and execution of an annual plan outlining timely and market-relevant content for quarterly business review.
• Direct involvement in the review and analysis of contract proposals, performance guarantees, renewals, and other payer-related activities.
• Direct involvement in the creation of Fairview Specialty Pharmacy’s responses to “Requests for Proposals” (RFP/s) and/or “Requests for Information” (RFI/s) focused on obtaining additional payer or employer clients, members and/or partners.
  
  
  

Product Development (20%)

• Leads analytics-based product delivery from inception to implementation.
• Creates and successfully implements innovative products and services:
• to manage costs, improve outcomes, and improve member satisfaction while differentiating Fairview Specialty as a market leader.
• for use within M Health Fairview to help differentiate M Health Fairview as a market leader related to overall Specialty management.
  

The ideal candidate will have a passion for crafting and selling a vision for the specialty analytics product, collecting requirements from customers, and working with teams to serve both internal and external stakeholders at a best-in-class level.

Required

Education

• MBA/MHA or PharmD degree and/or equivalent in specific applicable work experience. *Equivalent experience equals an additional 3 years instead of a Master’s or PharmD degree
  
  
  

Experience

• 15 years relevant work experience in strategy development and account management, in the PBM, specialty pharmacy, and/or managed care industry.
• 15 years of relevant work experience performing analytics in the PBM, specialty pharmacy, and/or managed care industry.
• 10 years of leadership/people management experience
• In-depth knowledge of payer/PBM economics and a strong understanding of key issues and market levers, given the changing US healthcare landscape.
• Ability to apply analytical insight to drive account performance and ability to “ask the right questions” of analytical resources.
• Experience with health outcomes and clinical analytics including utilization, access to care, quality outcomes, quality process and care gaps identification.
• Strong data interpretation/presentation and data visualization skills
• Experience must include working with health care transactional data (claims) and other health-related data sets as well as knowledge of federal and state laws pertaining to healthcare information privacy and security.
  
  
  

Benefit Overview

Fairview offers a generous benefit package including but not limited to medical, dental, vision plans, life insurance, short-term and long-term disability insurance, PTO and Sick and Safe Time, tuition reimbursement, retirement, early access to earned wages, and more! Please follow this link for additional information: https://www.fairview.org/careers/benefits/noncontract

Compensation Disclaimer

The posted pay range is for a 40-hour workweek (1.0 FTE). The actual rate of pay offered within this range may depend on several factors, such as FTE, skills, knowledge, relevant education, experience, and market conditions. Additionally, our organization values pay equity and considers the internal equity of our team when making any offer. Hiring at the maximum of the range is not typical.

EEO Statement

EEO/AA Employer/Vet/Disabled: All qualified applicants will receive consideration without regard to any lawfully protected status