Bridgewater, NJ, 08807, USA
50 days ago
Specialist, Managed Care Operations
**Job Title:** Specialist, Managed Care Operations **Location** : Bridgewater, NJ **About the Job** The Managed Care Specialist is responsible for contract management for various markets including Commercial Contracts, Medicare Part D and Managed Medicaid. This position will support National Pharmaceutical Benefit Manager (PBM) customers. Responsibilities include timely and accurate loading of contracts and amendments, eligibility, and adjudicating payments in accordance with contracted terms and conditions across Sanofi’s pharmaceutical portfolio in multiple systems including ECP (Electronic Claims Processor) and Revenue Manager (Model N administration system). This position will analyze and pay rebates based on contract language, formulary placement and utilization management policies. The candidate will have a fundamental understanding of contract strategies, markets and Sanofi products and will prepare invoice payment results providing insights and feedback on trends and issues. The Specialist will work in close cooperation with Managed Care Operations colleagues and counterparts in Contract Development, the Account team, Legal, Pricing & Analytics and Digital. We are an innovative global healthcare company, committed to transforming the lives of people with immune challenges, rare diseases and blood disorders, cancers, and neurological disorders. From R&D to sales, our talented teams work together, revolutionizing treatment, continually improving products, understanding unmet needs, and connecting communities. We chase the miracles of science every single day, pursuing progress to make a real impact on millions of patients around the world. **Main Responsibilities:** + Manage all aspects of contracts of the assigned PBM/payor including fully understanding the terms and conditions to appropriately set up contracts, update for contract amendments and adjudicate claims accurately. Illustrate deep understanding of the contract and be able to effectively interpret and analyze key components of the contract. + Analyze rebate payments utilizing reporting tools and third party data sources illustrate rebates and market share trends. Robust understanding and analysis of variances vs. prior periods. Provide meaningful, concise trending and variance commentary to Senior Management as needed. + Cross functional communication with Contract Development and Account teams, ensuring understanding and awareness of customer issues. + Ensure accuracy of system validations including 340B + Verify that all product and eligible members comply with contract requirements + Analyze product formulary placement and utilization management policy to ensure appropriate contract tier placement and rebate payment. + Extensive interaction with both external customers and key internal stakeholders to resolve any data discrepancies + Analyze contract exceptions for interpretation in the system(s) for accuracy of calculations/process compliance + Ensure all payments are fully compliant with the terms of the contract + Provide accurate 3 month rolling Cash Flow forecast for customers + Participate in ad hoc projects **About You** + 2-4 years of work experience preferred + Strong Excel skills required + Model N experience preferred + Deep analytical skills and ability to dissect the intricate reasons of rebate trends and variances + Strong oral and written communication skills and ability to clearly communicate the complicated analysis to the business parties + Independent problem solving and leadership skills in managing the account + Financial experience preferred + Professional manner and tact + Organized, accurate and detail oriented, disciplined and dedicated to superior quality work + Strong sense of commitment and teamwork + Ability to work independently + Ability to multi-task and meet established deadlines + Proficient in Microsoft Office Tools **Education** + Bachelor’s Degree is required, with a Finance or Business concentration preferred **Why Choose Us?** + Bring the miracles of science to life alongside a supportive, future-focused team. + Discover endless opportunities to grow your talent and drive your career, whether it’s through a promotion or lateral move, at home or internationally. + Enjoy a thoughtful, well-crafted rewards package that recognizes your contribution and amplifies your impact. + Take good care of yourself and your family, with a wide range of health and wellbeing benefits including high-quality healthcare, prevention and wellness programs and at least 14 weeks’ gender-neutral parental leave. Sanofi Inc. and its U.S. affiliates are Equal Opportunity and Affirmative Action employers committed to a culturally diverse workforce. All qualified applicants will receive consideration for employment without regard to race; color; creed; religion; national origin; age; ancestry; nationality; marital, domestic partnership or civil union status; sex, gender, gender identity or expression; affectional or sexual orientation; disability; veteran or military status or liability for military status; domestic violence victim status; atypical cellular or blood trait; genetic information (including the refusal to submit to genetic testing) or any other characteristic protected by law. \#GD-SG ​ \#LI-GZ \#LI-Onsite \#vhd **Pursue** **_progress_** **, discover** **_extraordinary_** Better is out there. Better medications, better outcomes, better science. But progress doesn’t happen without people – people from different backgrounds, in different locations, doing different roles, all united by one thing: a desire to make miracles happen. So, let’s be those people. At Sanofi, we provide equal opportunities to all regardless of race, colour, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, ability or gender identity. Watch our ALL IN video (https://www.youtube.com/watch?v=SkpDBZ-CJKw&t=67s) and check out our Diversity Equity and Inclusion actions at sanofi.com (https://www.sanofi.com/en/our-responsibility/equality-and-inclusiveness) ! _US and Puerto Rico Residents Only_ Sanofi Inc. and its U.S. affiliates are Equal Opportunity and Affirmative Action employers committed to a culturally inclusive and diverse workforce. All qualified applicants will receive consideration for employment without regard to race; color; creed; religion; national origin; age; ancestry; nationality; natural or protective hairstyles; marital, domestic partnership or civil union status; sex, gender, gender identity or expression; affectional or sexual orientation; disability; veteran or military status or liability for military status; domestic violence victim status; atypical cellular or blood trait; genetic information (including the refusal to submit to genetic testing) or any other characteristic protected by law. Sanofi is dedicated to supporting people through their health challenges. We are a global biopharmaceutical company focused on human health. We prevent illness with vaccines, provide innovative treatments to fight pain and ease suffering. We stand by the few who suffer from rare diseases and the millions with long-term chronic conditions. With more than 100,000 people in 100 countries, Sanofi is transforming scientific innovation into healthcare solutions around the globe. Discover more about us visiting www.sanofi.com or via our movie We are Sanofi (https://youtu.be/96EwNjb1TLo) As an organization, we change the practice of medicine; reinvent the way we work; and enable people to be their best versions in career and life. We are constantly moving and growing, making sure our people grow with us. Our working environment helps us build a dynamic and inclusive workplace operating on trust and respect and allows employees to live the life they want to live. All in for Diversity, Equity and Inclusion at Sanofi - YouTube (http://www.youtube.com/watch?v=SkpDBZ-CJKw&t=2s)
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