Manager II Managed Care Payment

Address: USA-ME-Scarborough-145 Pleasant Hill Rd
Store Code: Patient Health Services (2761713)
Ahold Delhaize USA, a division of global food retailer Ahold Delhaize, is part of the U.S. family of brands, which includes five leading omnichannel grocery brands - Food Lion, Giant Food, The GIANT Company, Hannaford and Stop & Shop. Our associates support the brands with a wide range of services, including Finance, Legal, Sustainability, Commercial, Digital and E-commerce, Technology and more.
Contributes to the growth and profitability of Brand pharmacies through contracting and relationship management activities with Managed Care payers. Responsible for Managed Care pharmacy network negotiations, contract implementation and management, performance monitoring, and relationship management. Primary external point of contact for Brand pharmacies to Pharmacy Benefit Managers (PBMs), Health Plans, Large Employer Groups and other entities that sponsor pharmacy provider networks. Negotiates on behalf of the Brands for inclusion in narrow or limited Managed Care payer networks and contractual terms, conditions, and financial terms that support the Brand strategic plans, goals, and financial objectives. Responsible for communicating financial implications to brand teams, and accounting counterparts. Manages a team responsible for payment analysis, claims rebilling, contractual implementation, and compliance standards execution.
*** Our flexible/ hybrid work schedule includes 3 in-person days at one of our core locations and 2 remote days. Our core office locations include Quincy, MA, Carlisle, PA, Scarborough, ME
Essential job functions:

• Manages activities supporting Brand participation in Managed Care pharmacy provider networks, including: solicitation of provider agreements, review and proposal of contract language, negotiation of reimbursement rates, and contract management and retention.
• Negotiates on behalf of Brand pharmacies and aligned with Brand strategic plans and financial objectives for inclusion within payer networks, including national, regional, and local broad and narrow networks sponsored by commercial or governmental payers.
• Provides financial analysis of solicitations and communicates to brands and provides as inputs to budgeting and forecasting processes.
• Manages relationship with switch, Medicare/medical vendors and accrediting bodies, overseeing team to create edits and communicate to brand operations.
• Provides oversight and support of pharmacy claims processing, transactional analysis and contract performance management including analysis and reconciliation of effective rate contracting & DIR or performance rebate impacts, as applicable.
• Builds and retains relationships with key payer network sponsors firms, including health plans, large employer groups, Medicare Plan sponsors, etc. Responsible for financial analysis and management guidance regarding new or adjusted payer network proposals, including reimbursement rates, contractual terms, compliance standards, and performance-based fees.
• Accountable for the execution and retention of all payer network agreements on behalf of Brand pharmacies. Primary point of pharmacy network sponsor contact on behalf of the Brands and responsible for the receipt, review and response to inbound payer communication as well as network provider manuals.
• Additional job duties may be assigned as needed to meet the needs of the business and support our Values.

Qualifications:

• Bachelor's Degree
• 5+ years' financial services experience
• 5+ years of leadership experience
• Excel knowledge with the capability of creating pivot tables, building reports, and VLOOKUP's
• Applicants must be currently authorized to work in the United States on a full-time basis until the end of their appointment

Preferred Qualifications:

• Relevant pharmacy industry experience
• Experience with negotiating contracts
• Understanding of P&L reports

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At Ahold Delhaize USA, we provide services to one of the largest portfolios of grocery companies in the nation, and we're actively seeking top talent. Our team shares a common motivation to drive change, take ownership and enable our brands to better care for their customers. We thrive on supporting great local grocery brands and their strategies.
We offer an experience where our associates are valued; Diversity, Equity, Inclusion and Belonging are infused in our business and our employees are representative of the communities that we serve. We believe in total wellness, which encompasses a blend of physical, financial and emotional wellness.
We believe in collaboration, curiosity, and continuous learning in all that we think, create and do. While building a culture where personal and professional growth are just as important as business growth, we invest in our people, empowering them to learn, grow and deliver at all levels of the business.
Job Requisition: 405331_external_USA-ME-Scarborough