Managed Care Account Manager/Director

POSITION SUMMARY

 

The Director of Managed Care has responsibility for managing PGxHealth’s Managed Markets in the US and Canada.  The Director of Managed Care has responsibility of managing all aspects of contracting with National and Regional Health plans as necessary to maximize patient access and minimize patient co-pays. 

 

The Director of Managed Care has responsibility to develop and manage contracts with the Health Plans, Nursing Home Providers, VA, Government Accounts, PHS, State Medicaid, and other key accounts.  The Director of Managed Care has responsibility to develop account level plans and goals that will help achieve business objectives.  They will have responsibility to constructively interact will all departments within the company; Sales Team, Sales Operations, Finance, Marketing, Legal, and Regulatory, to educate and appropriately update on price, contracts and pull through activities.

 

POSITION AUTHORITY

 

·  Authority for budget/financial resources and purchasing:

·  Financial management as it relates to distribution partners, i.e., warehouse, wholesalers and specialty pharmacies.

·  Authority to hire/fire: 

·  N/A at this time

·  Accountability for profit/loss or revenue: 

·  The Director of Managed Care has responsibility for maximizing the reimbursement rate for patient referrals by managing the product Access hotlines, our Specialty Pharmacy Partners and key managed care accounts.

·  Accountability for material assets/facilities:

·  . 

·  Accountability for business/client relationships: 

·  The Director of Managed Care is the senior field executive responsible for building and maintaining relationships with the company’s Channel customers.

·  Responsible to maintain positive and mutually beneficial relationships with all parties contracted to help with patient reimbursement, distribution, and payers. 

 

 

ESSENTIAL DUTIES, ROLES AND RESPONSIBILITES 

List the key roles and responsibilities, which are essential to the job.  The approximate percentage of time/effort spent on each responsibility should be indicated as a range, i.e. 20-25%.  Do not include duties that take up less than 5% of time/effort.

 

Time spent in each area of responsibility changes with the dynamics of the area of focus for the company’s development.  For the year 1/3 each would be appropriate.

 Trade and Channel ManagementIdentify and negotiate contract process with Health Plans in the US and CanadaIdentify and manage contract process with Government payers in the US and CanadaIdentify and support contract process for reimbursement servicesDevelop Specialty Pharmacy initial and advanced training on PGxHealth productsManage and trouble shoot relationships between Specialty PharmaciesManage the design and implementation of a Patient Assistance ProgramManage the design and implementation of a Foundation for a co-pay assistance program

 Reimbursement/Managed MarketsProvide support to Canadian reimbursement company to respond to third party payer issuesCommunicate pricing to appropriate agenciesDevelop and manage VA contractDevelop and manage DoD contractDevelop and manage contracts with each state Medicaid groupDevelop and manage creation of Formulary KitMonitor need for discounts/contractsMonitor changes in reimbursement modelsCoordinate with finance all pricing, discounts and contracts as it relates to ‘Best Price’ for Medicaid Reporting

 INTERNAL/EXTERNAL CONTACTS

Describe purpose and frequency of internal and external contacts.

 

·  The Director of Managed Care will interact regularly with Sales Management, Finance, Sales Operations, Legal and Regulatory. He or she will also interact regularly with customers, e.g., warehouse manager, specialty pharmacy managers, key manage market accounts, government payers. 

 

·  At designated times, the Director of Managed Care will interact with representatives of the company’s licensors interested in monitoring the progress of products they have licensed to PGxHealth or in soliciting ideas for new programs that should be considered.

 

·  The Director of Managed Care will have direct responsibility for supervising suppliers providing distribution and reimbursement services to the company.

 

SUPERVISION EXERCISED

 

·  This position will not have any direct reports initially but as the organization grows Account Managers may be added that would report to this individual.

   

SUPERVISION RECEIVED

 

·  The Director of Managed Care has considerable autonomy as a field based executive for the company and is expected to function with minimal supervision.

 

MINIMAL QUALIFICATIONS  

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the minimum knowledge, skills and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

·  Bachelor’s degree required.  Master’s degree preferred.

 

EXPERIENCE REQUIRED 

Describe minimum and preferred experience

 

·  A minimum of 10 years of experience in the pharmaceutical/diagnostic lab industry is required.

·  A minimum of 2 years of experience in National accounts in the pharmaceutical/biotechnology/ diagnostic testing industry is required.

·  Experience in selling prescription pharmaceuticals and/or pharmacogenomic testing products.

·  Previous exposure and/or experience in multiple functional areas within the pharmaceutical/biotechnology industry, e.g., sales training, sales operations, marketing, national accounts, is required.

SKILLS AND SPECIAL REQUIREMENTS

 

·  Ability to successfully navigate through the reimbursement environment.

·  Ability to analyze and interpret customer economics/financial performance.

·  Demonstrated professionalism and strong business ethics.

·  Strong analytical and financial skills in reporting and analyzing sales and expense data and identifying opportunities for improvement.

·  Strong results orientation.

·  Strong verbal and written communication skills. Excellent interpersonal and problem-solving skills. 

·  Strong organizational and time management skills.

·  Demonstrated leadership and mentoring skills in fostering outstanding performance from subordinates.

 Willingness to travel overnight. Approximately 60% overnight travel will be required