Supervisor, Managed Care Membership (50484418) Stamford, Connecticut
The primary objective of this position is to supervise the daily operations of the Managed Care Membership Group and the verification of plan compliance with the eligibility terms of Purdues commercial and Medicare Part D managed care contracts. The Supervisor will be responsible for the groups timely and accurate review of formularies and plan information, the updating of membership eligibility in the CARS / Contract Sphere system(s), and the recommendation of resolutions to eligibility-related disputes with managed care customers. The Supervisor will work closely with Managed Care Contract Specialists, Finance, Managed Care field personnel and external customers on any membership eligibility and compliance issues. The Supervisor also is responsible for evaluating group performance and providing various reports on membership and contract activity.
Overseeing the Managed Care Membership group which includes but is not limited to; a) reviewing of formularies and plan information for compliance with the terms of Purdue's managed care agreements, b) reviewing and updating Revitas CARS / Contract Sphere of any changes to membership eligibility for the managed care contracted customers, c) providing direction to assist membership team with dispute situations and providing insights and leadership to gain consensus internally, d) creating and implementing process improvement initiatives, and e) providing all supervisory tasks such as performance appraisals, objective setting, coaching, and development planning of direct reports in the Managed Care Membership group.
The Supervisor will be responsible for the oversight of all membership compliance and eligibility and thus will be expected to implement processes designed to optimize operational and resource efficiencies.
The Supervisor is expected to be a power user in CARS / Contract Sphere and AMM (within Revitas CARS / Contract Sphere contract application system), to ensure system optimization by the team. The Supervisor will manage any testing of Revitas CARS / Contract Sphere and AMM (or other related software) as they relate to contract membership administration.
Provide general support to the Senior Manager, Managed Care Contracting by providing reports, process improvement initiatives and recommendations on policy improvements.
Development of and updating of Standard Operating Procedures and work instructions relating to the overall membership function for Purdue. Ensure that such procedures and work instructions are communicated to staff timely and accurately.
Provide input in contract negotiations to the Contract Specialists on issues related to membership and data reporting requirements such as plan lists, formularies, NCPDP fields and supporting language.
Work cross-functionally with Finance rebate group Manager to improve operational efficiency and effectiveness including (a) evaluating existing operations and developing new approaches if necessary, (b) resolving complex compliance issues or membership disputes impacting rebate payments, and (c) prioritizing issues impacting contract membership administration as it affects rebate processing.
Work with Managed Care to develop relationships with managed care customers to maximize process efficiencies with membership updates and move to a better partnership with customers. This involves interacting directly with customers via email, phone, and in person meetings.
Develop rebate eligibility compliance and membership reporting that can be utilized by applicable internal groups.
Attend industry conferences to gain insights and stay abreast of trends which will assist in improving Membership processes as related to Managed Care contracts.
4-year Undergraduate degree required.
Required Experience & Technical Requirements
Computer Skills: Proficient in Outlook, MS Excel and MS Word. Knowledge of SAP and CARS / Contract Sphere or other pharmaceutical contract/rebate/membership systems helpful and Microsoft office.
Market understanding: Good understanding of managed care and pharmaceutical industry required.
Organization skills: Must possess good capability of organization skills and ability to manage multiple projects at one time.
Work Experience: Minimum of 3-6 years of work experience in managed care or analytical area. Preferred is one year minimum of direct supervisory or team lead experience.