What are the responsibilities and job description for the Specialist, Managed Care Operations position at Sanofi?
Job Title : Specialist, Managed Care Operations
Location : Bridgewater, NJ
About the Job
The Managed Care Specialist is responsible for contract management for various markets including Commercial Contracts, Medicare Part D and Managed Medicaid. This position will support National Pharmaceutical Benefit Manager (PBM) customers. Responsibilities include timely and accurate loading of contracts and amendments, eligibility, and adjudicating payments in accordance with contracted terms and conditions across Sanofi's pharmaceutical portfolio in multiple systems including ECP (Electronic Claims Processor) and Revenue Manager (Model N administration system). This position will analyze and pay rebates based on contract language, formulary placement and utilization management policies. The candidate will have a fundamental understanding of contract strategies, markets and Sanofi products and will prepare invoice payment results providing insights and feedback on trends and issues. The Specialist will work in close cooperation with Managed Care Operations colleagues and counterparts in Contract Development, the Account team, Legal, Pricing & Analytics and Digital.
We are an innovative global healthcare company, committed to transforming the lives of people with immune challenges, rare diseases and blood disorders, cancers, and neurological disorders. From R&D to sales, our talented teams work together, revolutionizing treatment, continually improving products, understanding unmet needs, and connecting communities. We chase the miracles of science every single day, pursuing progress to make a real impact on millions of patients around the world.
Main Responsibilities :
- Manage all aspects of contracts of the assigned PBM / payor including fully understanding the terms and conditions to appropriately set up contracts, update for contract amendments and adjudicate claims accurately. Illustrate deep understanding of the contract and be able to effectively interpret and analyze key components of the contract.
- Analyze rebate payments utilizing reporting tools and third party data sources illustrate rebates and market share trends. Robust understanding and analysis of variances vs. prior periods. Provide meaningful, concise trending and variance commentary to Senior Management as needed.
- Cross functional communication with Contract Development and Account teams, ensuring understanding and awareness of customer issues.
- Ensure accuracy of system validations including 340B
- Verify that all product and eligible members comply with contract requirements
- Analyze product formulary placement and utilization management policy to ensure appropriate contract tier placement and rebate payment.
- Extensive interaction with both external customers and key internal stakeholders to resolve any data discrepancies
- Analyze contract exceptions for interpretation in the system(s) for accuracy of calculations / process compliance
- Ensure all payments are fully compliant with the terms of the contract
- Provide accurate 3 month rolling Cash Flow forecast for customers
- Participate in ad hoc projects
About You
Education
Why Choose Us?
Sanofi Inc. and its U.S. affiliates are Equal Opportunity and Affirmative Action employers committed to a culturally diverse workforce. All qualified applicants will receive consideration for employment without regard to race; color; creed; religion; national origin; age; ancestry; nationality; marital, domestic partnership or civil union status; sex, gender, gender identity or expression; affectional or sexual orientation; disability; veteran or military status or liability for military status; domestic violence victim status; atypical cellular or blood trait; genetic information (including the refusal to submit to genetic testing) or any other characteristic protected by law.
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Pursue progress, discover extraordinary
Better is out there. Better medications, better outcomes, better science. But progress doesn't happen without people - people from different backgrounds, in different locations, doing different roles, all united by one thing : a desire to make miracles happen. So, let's be those people.
At Sanofi, we provide equal opportunities to all regardless of race, colour, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, ability or gender identity.
Watch our ALL IN video and check out our Diversity Equity and Inclusion actions at sanofi.com!
US and Puerto Rico Residents Only
Sanofi Inc. and its U.S. affiliates are Equal Opportunity and Affirmative Action employers committed to a culturally inclusive and diverse workforce. All qualified applicants will receive consideration for employment without regard to race; color; creed; religion; national origin; age; ancestry; nationality; natural or protective hairstyles; marital, domestic partnership or civil union status; sex, gender, gender identity or expression; affectional or sexual orientation; disability; veteran or military status or liability for military status; domestic violence victim status; atypical cellular or blood trait; genetic information (including the refusal to submit to genetic testing) or any other characteristic protected by law.
