Vice President & General Manager, Commercial Health Plan Man…

Purpose

The Vice President and General Manager, Commercial Health Plan Management leads the development and execution of the strategic business plan for the Commercial market segment. This position identifies and prioritizes investments in capabilities, systems and programs that enhance market competitiveness and works collaboratively with internal and external stakeholders to advocate for solutions aligned to the company and client’s growth objectives. This role is also responsible for providing strategic direction and general guidance to Regional Vice Presidents based on a deep understanding of client needs and Prime’s strategic direction.

Responsibilities

• Develop, implement, and oversee a multi-year growth and retention strategy within the Commercial and Health Insurance Marketplace (HIM) segments
• Ensure alignment with stakeholders on the delivery of core and expanded capabilities, growth opportunities and ongoing market competitiveness; set strategic direction with a strong analysis of the market direction/intelligence and create demand for new products/services in the marketplace
• Instill a culture of continuous improvement, setting objectives to regularly evaluate and improve process and procedures; ensure operations meet client requirements in a lean and efficient manner through measures of efficiency, effectiveness and continuous improvement
• Provide leadership and oversight to the Commercial and HIM teams by developing methodologies, processes and reporting capabilities that inform and support the delivery of Prime’s value proposition to the client; identify key performance indicators and establish reporting dashboards to monitor and influence performance; define clear and measurable account management objectives and direct the identification, development and expansion of client relationships
• Identify key internal and external relationships necessary to deliver core and expanded capabilities, drive growth, and ensure market competitiveness, including but not limited to executive sponsors, Blue Cross Blue Shield (BCBS) plans, national benefits consultants, key state leaders, industry trade associations, Centers for Medicare and Medicaid Services (CMS), and other contacts/organizations; establish an effective communication and collaboration cadence to foster ongoing partnership and respond to market/competitive threats (i.e. coalitions) and to ensure program compliance, operational best practices and industry leading innovation; leverage key insights to support, advocate for, and contribute to the development and deployment of intellectual capital and products
• Develop a recurring process to solicit product, financial and contracting feedback from the market and establish a framework for regular internal dialogue on how to respond to these requests; lead market-based planning and execution initiatives across the broader client engagement teams
• Leverage a deep knowledge of the competitive Pharmacy Benefit Management (PBM) landscape to analyze and interpret market and industry trends; provide insight to sales, product management and other key internal partners regarding opportunities for service and product innovation
• Oversee and manage departmental and client project budgets; prioritize project and investment requests and monitor expense trends to meet and exceed business profitability objectives while maintaining high levels of quality and customer services
• Manage department budget, staffing, performance and development, and consistently demonstrate Prime’s leadership expectations during interactions with direct reports, cross functional and external stakeholders
• Other duties as assigned

Minimum Qualifications

• Bachelors degree in Finance, Business, Health Care Administration, or related area of study
• 15 years of relevant work experience in PBM, pharmacy, health plan and/or managed care, including strategy development, budget management, and 5 years of sales or account management experience
• 9 years of leadership/people management experience
• Must be eligible to work in the United States without need for work visa or residency sponsorship

Additional Qualifications

• Exceptional communication skills with ability to communicate complex information to a variety of audiences
• Exceptional client relationship management and cross-functional team building skills
• Strong analytical and critical thinking skills; able to synthesize information from multiple sources into actionable plans
• Able to balance and prioritize compliance, business and other competing goals and risks, while still driving programs and initiatives to completion
• Ability to establish rapport and effectively influence at all levels within an organization
• Strong financial acumen

Preferred Qualifications

• MBA or other advanced degree

Minimum Physical Job Requirements

• Ability to travel up to 50% of the time
• Constantly required to sit, use hands to handle or feel, talk and hear
• Frequently required to reach with hands and arms
• Occasionally required to stand, walk and stoop, kneel, and crouch
• Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus

Reporting Structure

• Reports to the Senior Vice President Commercial and Government Markets

Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage qualified minority, female, veteran, disabled, and other diverse candidates to apply and be considered for open positions.