AVP, PBM Pharmacy Relations Management (Remote)

Job Description
Job Summary
Establish and manage business processes required to maintain valued relationships with services delegated to the Pharmacy Benefit Manager (PBM). Ensures PBM delivery of pharmacy networks with clear objectives, policies, standards, guidelines, and regulatory compliance for Molina markets within the pharmacy network distribution channels. Ensures operational reliability and excellence of pharmacy services executed through our partnership for delegated services.
Job Duties
Identifies and addresses emerging contractual issues within our PBM relationship and industry.
Responsible for the PBM to Molina relationship, to ensure the PBM and Molina shared services organizations develop and maintain optimal business processes that impact the Molina pharmacy benefit for members and payors. This includes ensuring that data governance, data management, and other subject matter experts (SME) for pharmacy data, along with shared services teams (IT, Member Services, Payment Integrity, Risk and Quality, Customer Experience) are able to access data from the PBM needed to conduct necessary pharmacy management. Acts as an escalation liaison with PBM to ensure data governance/management issues are addressed timely.
Acts as escalation liaison with PBM for all Molina analytics teams (e.g., MedEcon, Finance, Actuarial) to ensure optimal availability of high-value dashboard and reporting tools are available to pharmacy team.
Executive Pharmacy Liaison with Health Plan Leadership and internal Government Contracting/Affairs. Advise on responses to pending legislation and work with Health Plans to understand PBM landscape and capabilities, developing strategies to optimize Molina’s market position to ensure competitive structure for pharmacy management. Positions Molina Healthcare as a “thought leader” and differentiated partner in serving key stakeholder groups by anticipating the impact that delegated functions (to the PBM) have on membership, providers, and regulators. As needed, represent Molina as subject matter expert (SME) for PBM delegated functions.
Working with internal/external legal counsel and consultants for PBM services, negotiating agreements that support and promote Molina’s competitive advantage, ensuring clear and concise contracts compliant with state and federal requirements. In addition, assess new business combinations (e.g., mergers, acquisitions) with these constituents.
Contract with and coordinate services provided from pharmacy consultants. Oversee and manage third party audits of PBM services provided to Molina and our pharmacy vendors as appropriate.
Contract Services with other selected pharmacy service vendors as required and approved by pharmacy clinical and /or operations teams.
Assess new product offerings from PBM; contract for new services as approved by pharmacy clinical and/or operations teams.
Promote a culture of operational and regulatory compliance, especially through PBM delegated functions. Support an escalation channel to PBM to ensure operations are in compliance with all financial and internal operational controls, disclosure mandates relative to pharmacy operations, HIPPA and local state and federal regulations.
Provides executive leadership to assure the professional/management development at the individual level for direct reports to assure high performing Service Area teams and personnel necessary for the long-term success of Molina Healthcare Pharmacy Services.
Formulates and recommends Scorable Action Items (SAI’s), policies, plans, and programs and effectively negotiates with PBM to support successful execution of those SAI’s.
Works closely with pharmacy and clinical operations to formulate and implement policies, plans, and programs to effectively support Pharmacy Network and PBM oversight activities, including assuring the monitoring and evaluation of Pharmacy Networks, PBM and Molina Pharmacy in the area of compliance.
Manage departmental budgets.
Liaison with other Molina Pharmacy Services functions to support overall delivery of pharmacy cost savings and quality improvement initiatives, especially concerning the ongoing competitive nature of Molina’s PBM relationship.
Job Qualifications
REQUIRED EDUCATION:
Bachelor of Science Degree
REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:
10+ years working with PBM’s and their management of Pharmacy Network Channels (e.g., contracting with wholesaler, retail, specialty) for Health Plans.
Past experience with procurement of PBM services, Pharmacy Network management and understanding of fundamental pricing drivers of pharmacy costs, core operational interfaces (Eligibility, Claims Ops, Formulary & Benefit Plan administration), and impact of pharmacy data to reimbursement for pharmacy benefit administration.
Demonstrated experience in Pharmacy Network distributions channel management, monitoring, and relationship management within a delegated PBM services model.
Strong contract relationship management and negotiation experience, including clear understanding of legal and regulatory requirements through working collaboratively with legal, government contracting/affairs, and regional pharmacy management.
Strong collaboration skills within corporate shared services, internal pharmacy services leadership and external vendor partners.
PBM relationship management capabilities within a corporate shared services matrix model.
Strong oversight skills for program and project management and collaboration with shared corporate services (e.g., Integration Management Office). Proven track record of successful program/project implementation of complex change initiatives and process improvement projects that generated measurable improvements in productivity and profitability (vendor management, process change).
Demonstrated ability to achieve expected service and operational performance in a cost-competitive and efficient manner. Proven ability to effect change and meet business goals, monitor progress, and take correction actions when necessary.
PREFERRED EDUCATION:
MBA or MS
PREFERRED EXPERIENCE:
10+ years’ experience in Managed Medicaid Pharmacy experience
10+ years’ experience in Managed Medicare Pharmacy experience
Strong collaborator within corporate shared services matrix model
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $122,430.44 - $238,739.35 / ANNUAL

• Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.