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Use your strengths as a Director of Pharmacy Pricing & Operations at Wellmark!

About the role: As Director of Pharmacy Pricing & Operations, you will be a true change leader and help guide the vision and strategic direction for the Pricing and Operation teams at Wellmark. As a leader of others, you will directly impact the success, growth, and development of team members by setting clear expectations, coaching to each team member’s strengths, and fostering a team-centric work environment. Being a role model in behaviors that demonstrate Wellmark’s Leader Success Expectations and inclusion are essential. You will serve as a subject matter expert in all areas of pharmacy operations and pricing, including claims auditing and advancement of rebate performance and profitability for both clients and the plan. You will collaborate with other division leaders, such as Technology and Operations, to create and deliver a roadmap for success within Pharmacy Operations.

What does it take to make the cut? You believe health care can be better and are passionate about finding ways to influence this important work. You are proactive, analytical, innovative, and partner effectively with internal and external stakeholders. You have substantial experience in managed care pharmacy operations, pharmaceutical contract negotiation, and the systems and tools necessary to maximize drug affordability and operational excellence. The unknown and opportunity to build something from scratch excites you, because to you it is just another challenge to overcome on the path of rewarding, strategic work. You are also an experienced people-leader who believes mentorship and team member growth is the key to success. You love to teach and understand the benefits of transparent, dedicated leadership, because your team members’ individual achievements mean success for Wellmark.

a. Direct and oversee operations functions of the administration and delivery of pharmacy benefits. Work closely in collaboration with Procurement in managing PBM service and guarantees to Wellmark.

b. Develop processes to understand and drive management of rebate impacts of formulary strategies, pharma contract changes, public policy changes, and other market events. Develop, document, and communicate policies and procedures and process flows related to pharmacy benefit administration.

c. Responsible for leadership and oversight of a team focused on the identification and evaluation of strategies to optimize rebate value in response to pharmaceutical market events.

d. Lead a team that designs, develops, and delivers analytic solutions to inform rebate strategies and evaluate opportunities that will improve rebate and net cost performance.

e. Responsible for communicating analytical results and actionable trade insights to Pharmacy Services leadership as well as to other senior business leaders and must be able to clearly explain technical concepts to leaders with highly varied levels of technical background.

f. Provide day-to-day leadership of human resources, primarily focusing on leader and employee coaching, development, performance improvement, coordination and budgeting for pharmacy operation and finance/contracting team. Drive and produce results that are effective, accurate, and timely. Align work with department strategy and be on target to meet member, business and stakeholder needs.

g. Ensure that all Pharmacy-Health Services policy standards and business processes comply with regulations and sub-regulatory guidance related to pharmacy benefit management and administration and that there is alignment with corporate values that support and enhance the Pharmacy team functions and quality of healthcare services. Ensure policy is based on accepted standards of care.

h. Participate in the development of content in marketing and member materials including the drug formulary, Provider Directory, Evidence of Coverage, Summary of Benefits, Explanation of Benefits and member and provider communications. Responsible for implementing and maintaining quality assurance practices as they relate to written documentation.

i. Provide leadership and guidance, or participate in, various pharmacy benefit manager committees and project teams to ensure ongoing compliance, pharmacy benefit management and administration.

j. Provide pharmacy benefit operational leadership and serve as a respected SME for cross organization programs that involve pharmacy including health services, care management, medically benefited drug management and pricing strategies, member experience teams and Wellmark’s Payment Integrity Office.

k. Other duties as assigned.

This job requires a non-compete agreement.