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At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.
Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com.
Lead the pharmacy network and pricing strategy for PerformRx. Reporting to the President PerformRx, , this position is tasked with developing optimized models to support high-value partnerships with large retailers, PSAOs and independent pharmacy associations to leverage clinical services within these pharmacies to deliver clinical services to improve our members adherence to medications and attainment of quality standards. Working with plan leadership, value-based programs, and local network management teams, this position will be responsible for developing contracting methodologies consistent with pharmacy best-practices, leveraging Medicaid and Medicare experience, within and across markets. Ensures network provides person-centered, inclusive approach to effective and efficient community-based care in traditional and non-traditional care settings. Partner with PerformRx leadership in key areas, including but not limited to, annual strategic plan development, provider education strategy, prioritizing enhancements to provider/health plan interface(s), STARS reporting, and provider impact analysis. This role is also responsible for the overall management of network operations assuring networks are performing as expected within our adjudication platform.
Ensures the achievement of financial, quality, and clinical objectives through accomplishment of PerformRx initiatives.
Works with the leadership team to identify necessary business intelligence measures and acts as a liaison back to the network management teams where the reporting drives a required action.
Identifies and implements PerformRx programs structured to achieve clinical, operational and organizational objectives.
Manages projects related to improving the overall workflow efficiency of the PerformRx functions across the enterprise.
Job Scope: This is a key leadership role within PerformRx setting the strategy and innovation for our pharmacy network contracting and innovation strategies.
Organizational Impact: This role has a significant financial impact as it will help us to achieve improved costs of network which translates into savings for our plans and more competitive rates we are able to offer when bidding on new business.
Decision Making: This role will lead key decision making in the innovation of the network strategy and negotiating improved pricing parameters with the retailers within our network.
Master’s Degree preferred.
10 or more years network experience, PBM and health plan pharmacy experience.
Excellent written and oral presentation/communication skills.
Experience working in matrixed environments.
Effective leadership and analytical skills.
Ability to work collaboratively with internal and external stakeholders.