Company Overview:

Join us in our mission to transform healthcare! RxAdvance, now doing business as nirvanaHealth, is committed to bringing the art of possible to the payer and PBM industries, which is why we strive to invest in our employees throughout all stages of life. Success radiates through all levels of employees here, with competitive benefits, a strong focus on employee wellness, and optional education courses offered through UDEMY: we aim to support all aspects of employee growth.

Characterized by curiosity, innovation, and an entrepreneurial mindset, nirvanaHealth is the first to offer medical and pharmacy benefit management solutions that run on the same platform, made possible by our creation, Aria – the first robotic process automation cloud platform designed for healthcare.

Led by our chairperson John Sculley (former Apple CEO) and noted healthcare entrepreneur and founder of ikaSystems Ravi Ika, nirvanaHealth endeavors to sizably reduce the $900 billion in waste in healthcare administrative and medical costs. We are seeking A-players to join our team – folks who embrace the grind and hustle of a growing company, are collaborative and innovate, are life-long learners and growers, and have an entrepreneurial and positive mindset.

Job Summary:

The Director of Formulary Strategy and Rebate Operations will work with experienced industry professionals to optimize and ensure rebate value as presented by our PBM/GPO functioning as the rebate aggregator for nirvanaHealth’s client accounts. This individual will model “what-if” scenarios and conduct financial/member impact analyses to provide recommendations to client accounts.

The Director will work with our rebate aggregator, have full responsibility for rebate P&L and will lead the administration, collection, and reconciliation process for rebates. The director will frequently analyze clients’ rebates performance, ensure contract compliance, and regularly collaborate with rebate aggregator to explore opportunities or investigate discrepancies. This may include resolving rebate/invoicing discrepancies, any rebate disputes and verification of claim submission accuracy on a regular basis.

The individual will build strong working relationships with cross-functional teams such as Account Management, Clinical Innovation, Compliance, PA Ops, Sales, Pricing, etc., to ensure key financial terms and conditions are implemented accurately while maintaining a clinically sound formulary. They will also establish and maintain a positive relationship with external vendors and business partners, such as a PBM/GPO serving as our rebate aggregator.

Job Responsibilities (but not limited to): [PHARM Core 25 (d)]

• Conduct cost-benefit and rebate analysis of new and existing pharmaceuticals to guide. Formulary strategy and provide recommendations for client accounts across all lines of business.
• Play a pivotal role in negotiating, developing, and executing contracts.
• Capable of translating contractual terms into a robust quantitative model.
• Contribute to new client acquisition through repricing analyses.
• Monitor and ensure that all contracts are compliant with relevant state and federal rules.
• Explore and analyze new opportunities for company’s growth.
• Submit claims to rebate aggregator for rebate collection and allocate such collections appropriately across all clients and LOBs.
• On a regular basis, lead investigation of rejected reasons for claims deemed ineligible by rebate aggregator/manufacturer and project the financial impact of such claims.
• Receive, review, and approve contractual rebate guarantee and or pass-through payments and assure contract compliance.
• Regularly collaborate with IT support on creating, maintaining, and updating code and relevant tables necessary for accurate claim submissions.
• Prepare materials for, and oversee the process of invoicing external partners and paying clients.
• Review payment reports and supporting documentation; provide projections to Controller.
• Responsible for addressing any audit requests related to Commercial, Medicare (or any other LOB) claims submitted for rebate payments.
• Explore and analyze new opportunities for company’s growth.

• Works with VP to support recruiting, selection, orientation, and training of new employees.
• Ensures an engaged, safe, secure, and legal work environment.
• Develops, coordinates, and enforces systems, policies, procedures, and productivity standards.
• Other responsibilities and special projects as assigned.
• Identifies and develops personal growth opportunities.
• Have a thorough understanding of, and perform in compliance with, the current PBM v2.2 URAC standards applicable to the position.

Qualifications: [PHARM Core 25 (a) (b) (c)]

• Education and/or Training:
  • Bachelor’s degree in Finance, Accounting, Business Administration, or related field
  • MBA preferred.
  • 3 to 5 years industry experience in financial analysis and business/healthcare analytics strongly preferred.

• 
  Professional Experience:
  • At least 5 to 10 years of experience working in a PBM, Health Plan, Health System, or Healthcare consulting firm.
    • Knowledge of finance policies, practices, and systems
    • Ability to work with and analyze large pharmacy/drug data sets and claim files.
    • Knowledge of file layout for standard drug claims files and additional requirements specific to Medicare Part D
    • Experience in business-to-business pricing; PBM, health plan or pharmaceutical industry
    • Ability to adapt to changing priorities and manage multiple projects simultaneously.
      • Demonstrated track record of academic, professional, and personal success.
      • Advanced problem-solving skills and a can-do attitude

• 
  Licenses/Certifications:
  • n/a

• 
  Specialized Skills:
  • Strong organizational, time management skills and attention to detail.
  • Ability to multitask, ensure accuracy, and execute against pre-determined deadlines.
  • Team player with a collaborative working style who will be respectful and responsive to the needs of the cross-functional team.
  • Displays a sense of urgency to meet requests and deadlines in a fast-paced environment.
  • Demonstrated results orientation and follow-through.
  • Proven effectiveness as a creative problem-solver.
  • Ability to develop and maintain positive relationships with colleagues, clients, and business partners.
  • Ability to challenge conventional approaches and think outside the box.
  • Highly motivated self-starter with a growth mindset; ability to initiate and manage multiple projects with minimal supervision.
  • Strong writing and presentation skills.

• 
  Technical Skills:
  • Proficiency with SQL and Tableau is required.

Strong PC skills; MS Word, Excel, Access, and Advanced PowerPoint, Visio

• Additional Considerations:
  • Applicants must be able to pass a background investigation as all offers are pending a successful completion of background check per the company policy.

Physical and Mental Requirements:

• Physical Activities:
  • Some travel may be required. This is a hybrid role, and in-person office attendance is required.

• 
  Mental Activities:
  • General mental activity related to job duties.
  • Ability to prioritize and multi-task effectively.
  • Ensure accuracy and execute against pre-determined deadlines.