POSITION SUMMARY:

Clearway Health (CH) provide specialty pharmacy services to serve the complex medication needs of patients. Clearway Health will provide patients who require specialty drugs a comprehensive service program that includes an on-site pharmacy staffed with a care team that includes: Pharmacists, Pharmacy Technicians, and Pharmacy Liaisons. The Clearway Health approach is an unparalleled level of integration with the clinical team coupled with highly personalized service, thus driving better outcomes at lower cost.

Works independently under the general direction of the Industry Operations Director, work is seldom reviewed. The Payer/PBM Specialist regularly exercises discretion and judgement in execution of responsibilities serving as a liaison with payers and PBMs to ensure preferred access to payer networks.

Position: Payer/PBM Specialist (Specialty Pharmacist)        

Department: Industry Relations

Schedule: Full Time

ESSENTIAL RESPONSIBILITIES / DUTIES:

• Collaborates with Clearway teams and health system partners address payer and PBMs access and reimbursement challenges
• Builds effective working relationships with national and local payers, PBMs and PSAOs to ensure preferred access to their networks
• Reviews reimbursement rates and recommends improvements when necessary
• Evaluates managed care trends, coverage patterns and payer policies, and provides information and education to Clearway and health system partners as needed
• Attends corporate and site-based committee meetings and other ad hoc meetings with health system personnel as necessary to assess needs, communicate progress on specific projects and develop relationships.
• Maintains a thorough knowledge of payer policies and industry developments related to specialty pharmaceuticals

JOB REQUIREMENTS

EDUCATION:

• Bachelor’s degree in business administration, healthcare administration or a related field.

Preferred:

• Master’s degree in Business Administration.

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

EXPERIENCE:

• Minimum of 3 years of experience working in the health insurance or PBM industries

KNOWLEDGE AND SKILLS:

• Ability to apply critical thinking to complex situations, solve work-related problems and make decisions in a fast-pace environment
• Strong verbal and written communication skills for interacting with all levels both inside and outside the organization.
• Advanced knowledge and experience of strategic sourcing processes and methodologies.
• Demonstrated knowledge of contract structures, terms, conditions, risk mitigation and experience executing/drafting business requirements and key performance indicators in contracts.
• Proficient in the use of Microsoft Word, Excel, PowerPoint and Outlook.
• Ability to structure and prioritize work to achieve specific deliverables in an environment characterized by tight deadlines and competing priorities.

SPECIAL WORKING CONDITIONS (Responsible for on-call, 24 hour. coverage, etc.):

• Job functions to be completed remotely
• Occasional travel to client site and corporate meetings as needed

External and internal applicants, as well as position incumbents who become disabled as defined under the Americans With Disabilities Act, must be able to perform the essential job functions (as listed) either unaided or with the assistance of a reasonable accommodation to be determined by management on a case-by-case basis.