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Lider de Farmacia en Contencion de Costos
Lider de Farmacia en Contencion de Costos
Regular
Exempt
GENERAL DESCRIPTION
Responsible for overseeing the department’s financial activities, including budget management and savings initiatives. Develops, analyzes, and evaluates pharmacy savings programs and continuously monitors their financial impact. Ensures accurate budget planning, forecasting, and performance oversight. Translate operational and clinical needs into clear reporting by modeling and integrating data from multiple sources. These responsibilities support financial activities across all company lines of business.
- Lead and support Effective Medical Management (EMM) initiatives by establishing schedules, milestones, resources, and scope, and ensuring projects are well‑scoped, documented, and completed on time, with regular updates to executive sponsors and stakeholders.
- Participate in high‑impact corporate initiatives, collecting requirements and creating solutions that monitor performance metrics and facilitate operational and clinical analyses.
- Meet with providers and participate in committees or work sessions to gather requirements and serve as a technical pharmacy expert for developing solutions that support accurate savings calculations and final reporting.
- Collaborate with key stakeholders to identify gaps, barriers, and opportunities for improvement, and implement enhancements aligned with pharmacy and financial objectives.
- Develop and resolve issues proactively before health plan performance is impacted, identifying and reporting significant problems with proposed solutions to leadership.
- Oversee PBM financial guarantees and Maximum Allowable Cost (MAC) pricing processes, performing gap analyses, variance identification, and implementing corrective actions with PBM.
- Work with Finance, Actuarial, and Pharmacy Benefit Management (PBM) teams on departmental budget preparation, providing drug utilization and cost trend analysis, and serving as liaison for reporting needs.
- Analyze and present drug cost trends and variances, interpreting utilization reports, identifying drivers, and developing initiatives with clinical and PBM teams to close gaps and monitor effectiveness.
- Perform savings projections analysis and monitoring, documenting calculation logic and supporting reports for each EMM initiative.
- Develop integrated reports from multiple databases, analyze patterns and trends to support senior management decision‑making, prepare presentations for internal/external audiences, and perform financial analysis tracking and trends.
- Validate vendor invoices for accuracy and compliance with contracts, resolving discrepancies promptly and collaborating with stakeholders to prevent future issues.
- Ensure compliance and quality standards, collaborating in audits, automation initiatives, and cross‑functional initiatives to meet local and federal regulations.
- Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
- May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.
MINIMUM QUALIFICATIONS
Education and experience: Bachelor's Degree in Business Administration, Science, Public Health, Financial Analysis, or related areas. At least five (5) years of experience in savings modeling, forecasting, variance analysis, data management, and performance monitoring, with a strong track record leading cross-functional initiatives, supporting regulatory and compliance requirements, and driving change-management and workflow improvements, with preferred experience in the Healthcare Industry or Clinical Drugs Management.
"Proven experience may be replaced by previously established requirements."
Certifications / Licenses: N/A
Other: Intermediate to advanced knowledge of Excel is required, and Power BI knowledge is preferred. Knowledge in analyzing and managing tables and data.
Languages:
Spanish – Advanced (writing, conversational, comprehension, and reading)
English – Advanced (writing, conversational, comprehension, and reading)
“We are an Equal Employment Opportunity Employer and take Affirmative Action to recruit Protected Veterans and Individuals with Disabilities.”
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