• Job Description

  Req#: J260454

  Company :

  Highmark Inc.

  Job Description :

  JOB SUMMARY

  This role leads a team responsible for the development and implementation of innovative prescription drug benefit strategies and programs specifically for the Medicare Advantage (MA) market. The incumbent will manage a team of clinical and non-clinical professionals, driving the design and launch of pharmacy solutions that are compliant, clinically effective, and financially sound. This position demands a highly collaborative leadership style, characterized by strong communication, negotiation, and consensus-building skills. A proven ability to navigate complex regulatory landscapes (including CMS compliance) and a comfort level tackling ambiguous, high-stakes challenges is crucial for success.

  Responsibilities will include:

  • Strategic Leadership: Developing and executing the organization's MA pharmacy strategy, including formulary management, benefit design, and program development. This requires a deep understanding of the MA market, competitive landscape, and regulatory requirements, including the implications of the Inflation Reduction Act.
  • Team Management & Mentorship: Leading and mentoring a team of professionals in a matrixed environment, fostering collaboration and driving performance toward ambitious goals. Proven experience managing and developing direct reports is essential.
  • Cross-functional Collaboration: Working closely with sales, segment support, finance, clinical operations, and other key stakeholders to ensure seamless product development, launch, and ongoing performance. This requires strong communication, negotiation, and influencing skills.
  • Financial Acumen: Developing and managing budgets, identifying revenue opportunities, and contributing to the overall financial success of the MA business segment. Demonstrated ability to analyze financial data and make informed decisions is essential.
  • Problem-Solving & Decision-Making: Addressing complex challenges requiring innovative solutions, decisive action, and a strategic approach to mitigate risk and maximize opportunities.

  While this role focuses predominantly on Medicare Advantage, collaboration with other business segments (ACA and Commercial) may occur on a limited, strategic basis. The ideal candidate possesses exceptional problem-solving skills, thrives in a fast-paced environment, and consistently demonstrates professional maturity and judgment.

  ESSENTIAL RESPONSIBILITIES

  • Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plans, organizes, staffs, directs and controls the day-to-day operations of the department; develops and implements policies and programs as necessary; may have budgetary responsibility and authority.
  • Manages the day-to-day operations facilitating the development and implementation of the Organization’s prescription drug benefit strategies and products tailored to support their applicable core business segment(s), including the Commercial (self-funded and risk)/Healthcare Reform (ACA) business segments, or the Medicare Advantage business segment.
  • Manage deployment of pharmacy product solutions from pilot to full-scale rollout while ensuring all capabilities deliver administrative effectiveness, support market competitiveness/differentiation, customer satisfaction and financial performance.
  • Ensures pharmacy programs and products are monitored and maintained in accordance with contracts, polices, state and federal regulations, as applicable.
  • Collaborate with key internal and external stakeholders, including other market segment support and product teams and pharmacy vendors (including PBM)
  • Other duties as assigned or requested.

  
  EDUCATION

  Required

  • Bachelor's degree in Business, healthcare or related field, or relevant experience and/or education as determined by the company in lieu of bachelor's degree

  Preferred

  • Master's degree in Business, healthcare (i.e. PharmD) or related field

  
  EXPERIENCE

  
  Required

  • None

  Preferred

  • None

  LICENSES or CERTIFICATIONS

  
  Required

  • 5 years in a Health Plan or Pharmacy Benefit Manager (PBM)

  • 3 years of leading healthcare program or product development

  Preferred

  • None

  
  SKILLS

  • Analytical and logical reasoning/thinking
  • Problem solving and decision making
  • Oral and written communication skills
  • Management
  • Team buiding

  
  Language (Other than English):

  None

  Travel Requirement:

  0% - 25%

  PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

  Position Type

  Office-based

  Teaches / trains others regularly

  Occasionally

  Travel regularly from the office to various work sites or from site-to-site

  Occasionally

  Works primarily out-of-the office selling products/services (sales employees)

  Never

  Physical work site required

  Yes

  Lifting: up to 10 pounds

  Constantly

  Lifting: 10 to 25 pounds

  Occasionally

  Lifting: 25 to 50 pounds

  Rarely

  Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
  
  Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
  
  As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
  
  Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training

  Pay Range Minimum:

  $92,300.00

  Pay Range Maximum:

  $172,500.00

  Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

  Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

  We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.

  For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

  California Consumer Privacy Act Employees, Contractors, and Applicants Notice

• About the company

  A national health and wellness organization as well as the second-largest integrated delivery and financing system in America.

Notice