Senior PBM Oversight Coordinator

Senior PBM (Pharmacy Benefit Manager) Oversight Coordinator

Location: Birmingham, AL

Work Schedule: This is a hybrid position with regular work performed at the VIVA HEALTH corporate headquarters in downtown Birmingham and some work-from-home opportunities.

Why VIVA HEALTH?

VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.

VIVA HEALTH has consistently been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.

Job Description

The Senior Pharmacy Benefit Manager Oversight Coordinator is responsible for the overall management and health plan oversight of our Pharmacy Benefit Managers (PBMs) and pharmacy operations related services (through the PBM directly, as well as vendors contracted directly or through the PBM) for all lines of business including Medicare and Commercial. This role includes services provided and applicable to both the pharmacy drug benefit and the medical drug benefit. This position works collaboratively with the PBM, outside consulting firms, and other internal stakeholders to ensure that the PBM is meeting financial and business obligations as well as contractual and compliance requirements.

This individual will serve as the primary day to day contact and be accountable for managing all Request for Proposal (RFP) projects, plan and program implementations, contract negotiations, and performance and issue management functions related to the PBMs.

Key Responsibilities

• Coordinate the selection and contracting of a qualified consulting firm to facilitate PBM requests for proposals, annual market checks, and PBM audits and serves as the consultant’s primary point of contact.
• Ensure market checks and RFPs are conducted in a timely to manner to maximize health plan leverage during contract negotiations and coordinates timely follow-up during the back and forth review of contract terms.
• Oversee PBM contract negotiations and maintain accountability for the PBM contracts in place. Serve as the subject matter expert for the health plan’s PBM agreements.
• Monitor the financial terms of the PBM agreements versus benchmarks and stay abreast of best practices in PBM negotiations to reduce health plan expense and increase service levels.
• Monitor and audit PBM performance on core functions and any additional programs the health plan elects to ensure compliance with contract terms, health plan service level expectations, and regulatory requirements. Maintain key metrics needed for PBM oversight and contract negotiation.

REQUIRED:

• Bachelor’s degree
• At least 5 years of experience in the healthcare industry
• Minimum of 5 years' experience in contract management or vendor oversight
• Demonstrated analytical, critical thinking, and problem-solving skills
• Ability to influence others to achieve business unit objectives
• Ability to review and analyze complex contracts and negotiate favorable contract terms
• Ability to communicate effectively (both written and oral) with employees at all levels of the organization, as well as with key individuals outside the organization, such as vendors and consultants
• Experience working directly with executive leadership, managing vendor relationships, and serving as a liaison to external clients
• Ability to prioritize work and meet deadlines as well as overcome barriers or setbacks

PREFERRED:

• Master’s Degree or Law Degree
• Experience in PBM industry
• Experience in PBM contract management or PBM oversight
• Strong business acumen with experience in the PBM industry and knowledge of PBM related services
• Experience overseeing healthcare/PBM contracts and related negotiations and oversight
• Demonstrated experience and proficiency with MS Office Outlook, Word, Excel, Power Point, and Adobe Acrobat Pro