Manager, Pharmacy Business Development

Let’s do great things, together!

About Moda
Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let’s be better together.

Position Summary
We are seeking a Manager of Pharmacy Business Development with a focus on industry relations. The domain expertise to be successful in this role requires foundational clinical pharmacy experience, accompanied by a high degree of business acumen, and an interest and passion for partnering closely with pharmaceutical and biotechnology companies, and other vendor partners who engage in contracting opportunities such as rebate management, and clinical programs. Overall, this position is responsible for development of strategic formulary approaches for the management of medications across the medical and pharmacy benefits, driving to low net cost medication utilization. This position includes reviewing rebate initiatives for medications covered under the pharmacy and medical benefits, across various lines of business including commercial, Exchange, Medicare and Managed Medicaid. The role includes facilitating or supporting the implementation of projects or activities with both external and internal stakeholders and articulating this value as necessary. The ideal candidate resides near or within commuting distance of our Portland, Oregon office to support a hybrid work arrangement, however, remote status will also be considered.

Pay Range
$136,786.84 - $174,406.91 annually (depending on experience)
*This role may be classified as hourly (non-exempt) depending on the applicant's location. Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.

Please fill out an application on our company page, linked below, to be considered for this position.

Benefits:

• Medical, Dental, Vision, Pharmacy, Life, & Disability
• 401K- Matching
• FSA
• Employee Assistance Program
• PTO and Company Paid Holidays

Required Skills, Experience & Education:

1. Doctor of Pharmacy degree (Pharm.D.) preferred, or Bachelors of Pharmacy degree.
2. Current active and unrestricted Oregon Registered Pharmacist license, or eligible for Oregon licensure which is to be obtained within 60 days of employment.
3. Past supervisory experience managing a team.
4. Three to five years of managed care experience, time can be inclusive of training from an accredited managed care residency program.
5. Experience with Commercial, Medicare, and/or Medicaid lines of business.
6. Experience managing contracts, particularly with biopharmaceutical manufacturers and other pharmacy vendors.
7. Technical understanding of pharmacy claims processing information and systems.
8. Strong analytical skills and business acumen.
9. Ability to communicate and present technical information appropriate for the audience.
10. Ability to work independently and collaborate cross-functionally with various stakeholders.
11. Project management skills and the ability to plan and execute projects as assigned.
12. Commitment to service, organization values, and professionalism.
13. Ability to maintain confidentiality and project a professional business image.
14. Works well under pressure with frequent interruptions and shifting priorities.
15. Ability to work independently.
16. Proficient with Microsoft Office applications such as Word, Excel, Outlook, and PowerPoint.

Primary Functions:

1. Lead industry relations and rebate strategies for medical and pharmacy benefit medications, and new and emerging therapies, across all lines of business.
2. Oversee all rebate partners and lead evaluations of new potential partners.
3. Identify and negotiate direct contracts with biopharmaceutical partners.
4. Identify, manage, and assess the value of unique vendor partnerships to advance pharmacy programs, including drug information resources, medical management organizations, digital therapeutics, and point of service solutions.
5. Responsible for ensuring compliance with rebate contracts, rebate terms within client contracts, and contracts held with other vendor partners.
6. Lead rebate modeling and optimize rebate scenarios and bid selections based on client specific goals and strategies.
7. Oversee pipeline developments, including market events and material changes to therapeutic categories, for new and emerging therapies, specialty, and traditional medications, and keeps internal and external stakeholders apprised of such events. Develops educational materials as needed.
8. Leads custom formulary rebate offerings and recommendations for downstream clients.
9. In collaboration with other pharmacy leaders, develop enterprise-wide industry relations strategy.
10. Oversee, develop and manage Moda’s Industry Relations team.
11. Lead rebate offerings for existing therapeutic strategies which support ongoing formulary performance, but also identify new opportunities either as contracting changes or new market entrants are FDA-approved.
12. Work closely with vendor partners (PBM, medical management companies, others) on policy or formulary changes driven by cost analysis, including rebate considerations or contracting.
13. Support and/or lead client facing presentations within industry relations as necessary.
14. Responsible for information gathering with legal and/or regulatory teams to understand impact to current formulary strategies, with financial implications, to anticipate or plan for any potential compliance driven update due to changes in existing, or new and emerging states of business.
15. Monitor, anticipate changes, and prepare for pipeline and market events.
16. Develop concise, applicable, comprehensive, and timely communiques as assigned for members, providers, internal, or external stakeholders.
17. Provide clinical support services that intersect industry relations or business development, including but not limited to benefit design, formulary analysis, drug information, P&T participation, client support, and drug utilization management.
18. Contribute, update, and maintain policies and procedures related to industry relations.
19. Complete significant projects and performs all other related duties as assigned.
20. Follow the company HR policies, Code of Conduct, and all department policies and procedures including protecting confidential company, employee, and customer information.

Working Conditions & Contact with Others

• Remote, office environment, and/or hybrid with extensive close PC and keyboard work, and constant sitting. Work in excess of 40 hours per week, including evenings and occasional weekends, to meet business needs. May require occasional travel to conferences or offsite business meetings.
• Internally with Clinical Pharmacy, Analytics, Marketing, Sales & Account Services, Actuary & Underwriting, Healthcare Services, Medicare and Medicaid Programs, Benefits, Legal, Regulatory Affairs, and Compliance. Externally with PBM, medical management vendor, pharmaceutical and biotechnology manufacturers, consultants and benefit managers, clients, providers, and pharmacists.

Together, we can be more. We can be better.

Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law. This is applicable to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training.

For more information regarding accommodations, please direct your questions to Kristy Nehler & Danielle Baker via our humanresources@modahealth.com email.