Director, Managed Care Rebate Operations (MCRO)/Government Pricing

Role Summary

This role is accountable for strategic and functional leadership of a team responsible for accurate and timely Managed Care Commercial and Medicare Part D rebate processing and payments, data stewardship and compliance in connection with matrix team's financial reporting (GTN, projections and budgets) as well as all aspects with evaluating implications of and reporting Managed Care data required for U.S. and Puerto Rico government pricing calculations.

Responsibilities

• Lead and develop a team responsible for systems and processes that collect, process, monitor and use Managed Care data for financial, business or government pricing calculation purposes including but not limited to rebate payments, GTN, projections, budgets, AMP, ASP, BP estimate, BP true-up, BP modeling of contingent/portfolio agreements, legal requests, SOX compliance, deal analytics, contract performance analytics and ad hoc data analytics
• Partner with other BMS functions to assist them in understanding all potential implications of various rebate deal structures
• Develop and maintain processes to estimate implications of contingent and portfolio rebate deal structures to inform business, financial and government pricing calculation
• Review and approve the monthly and quarterly Managed Care processes that support government pricing calculations including collaboration with legal colleagues to monitor the latest government contracting and reporting requirements, and ensure Managed Care government pricing calculation implications are identified and considered
• Serve as lead and provide guidance to the team to operationalize the BMS 340B strategy for Managed Care Rebate Operations and understand broader 340B landscape
• Lead team and work collaboratively with other internal and external partners on PBM conflict/dispute resolution
• Provide oversight for various aspects of external vendor contract negotiations, service level performance, system enhancements, system controls, and issue resolution
• Ensure maintenance of appropriate departmental SOPs and work with internal and external auditors and team to ensure SOX compliance of rebate processing and appropriate categorization of Managed Care data for financial forecasting and government pricing calculations
• Provide oversight for team and coordinate with Treasury for Manufacturer Discount Program (formerly Coverage Gap Discount Program) administration and payment responsibilities
• Champion process improvement initiatives as required
• Lead the team in the implementation and testing of Managed Care rebate systems (REACT$ and vendor interfaces)
• Lead and assist with special projects as required (IRA, Legal requests, dispute resolutions, etc.)
• Drive digital transformation by identifying opportunities to automate pricing processes and implement scalable digital tools
• Champion process innovation by evaluating current pricing practices and recommending digital enhancements to improve efficiency and accuracy

Qualifications

• A minimum of 10 years of experience in the pharmaceutical/healthcare industry related to Managed Care
• Experience with governmental pricing, bundled sales arrangements, financial processes, SAP and GTN systems and methodologies is required
• Strong technical/functional skills and an ability to motivate, develop, and lead others as a player/coach
• Possess strong interpersonal, communication and consensus building skills
• Proven history of leadership and experience with direct responsibility for supervising others
• Strong analytical skills and ability to think strategically about the impact of various contracting approaches and government regulations
• Firm understanding of the healthcare marketplace with a strong business acumen, including a solid understanding of the way various channels and customer types make money and create value
• Demonstrated ability to drive execution of key initiatives and meet all deadlines
• Proven ability to prioritize and work effectively in a fast-paced, dynamic environment
• Demonstrate critical thinking and business acumen to data reporting and compliance
• History of highly ethical and compliant behavior
• Proven ability to coach and network across a broad matrix organization to form strong, productive partnerships
• Must have strong attention to detail and reviewing skills for information prepared both by the team and/or submitted to the team with strict attention to controls and consistency with established processes
• Works comfortably within a matrix team environment providing oversight and guidance
• Proficiency with SOX controls, spreadsheet analysis, database management, and data delivery are required
• Strong written and oral communication skills and the ability to communicate effectively with all levels of the organization
• Demonstrated experience leveraging and/or implementing, AI-driven insights and digital tools to enhance customer engagement strategies, optimize HCP/patient experience, and drive data-informed commercial decision-making
• Experience with process automation technologies (e.g., RPA, workflow automation tools, or scripting) is highly desirable

Education

• Bachelor's degree in an analytical, financial, or business-related program or the equivalent