RxSense - Manager of Pricing
Requirements
• Hands-on experience owning MAC management in a PBM or pharmacy setting: building and maintaining MAC lists, managing MAC factor adjustments, and quality-checking pricing before it goes live. • Bachelor’s degree in finance, Business, Economics, or a related field; • 5 + years of PBM or retail pharmacy pricing experience, including direct MAC management, with at least two years in a supervisory or lead capacity; or equivalent combination of education and experience. • Working knowledge of PBM pricing economics, including client and pharmacy contract terms, pricing guarantees, and reconciliation. • Experience monitoring pricing performance against guarantees and turning variance into corrective pricing actions. • Experience setting up pricing for client implementations and renewals on tight timelines. • Ability to explain pricing clearly to non-technical partners and serve as a steady, credible resource to the business on pricing decisions. • Experience leading, coaching, or mentoring analysts and building documented, repeatable processes. • Advanced Excel skills. • SQL, Tableau, or other BI tools experience is preferred. • Experience adopting automated or AI-enabled pricing tools as a business owner, not necessarily as a builder is preferred. • Experience in a high-growth healthcare technology company is preferred.
Responsibilities
• Own MAC management for the Enterprise book: create, maintain, and update MAC lists, including client-specific and dedicated lists, so pricing is accurate, competitive, and aligned with client and pharmacy contracts. • Manage MAC factor and multiplier adjustments across clients, with quality assurance on every pricing export and upload before it goes live. • Monitor client and pharmacy pricing performance against contractual guarantees, surface gaps early, and develop pricing strategies to close them before year-end reconciliation. • Build and administer pricing for new and renewing clients, partnering with Client Experience and implementation teams so pricing is set up correctly and on time for each go-live. • Resolve MAC pricing escalations, appeals, and complex pricing tickets, and serve as the escalation point for pricing questions across the business. • Review client and pharmacy contract terms for pricing implications, and maintain accurate contract and pricing information as the basis for performance tracking. • Support quarterly and annual reconciliation of client and pharmacy contracts, and produce reporting and analysis for leadership on contract compliance and pricing performance. • Prioritize the inbound flow of pricing requests, set clear turnaround expectations with the business, and keep the team focused on the highest-value work. • Partner with Network Operations, Clinical, and Underwriting on pricing decisions that affect pharmacy networks, formulary, and new-business proposals. • Partner with the AI and data teams, who own the technical tooling, to define requirements for and adopt automated pricing tools, including algorithmic MAC management for a broader set of clients. • Lead, coach, and develop the pricing team, building documented, repeatable processes so MAC management has no single point of failure. • Perform ad hoc analysis on client and pharmacy performance, including volume trends, drug seasonality, and financial results. • What success looks like • MAC management runs reliably, with documented processes and no single point of failure. • Client and pharmacy guarantees are tracked and on plan, including through new client implementations. • The pricing team has a clear go-to for strategy and problem-solving, and the business has clear turnaround expectations. • Automated pricing tools from the AI and data teams are part of the team's regular workflow.
Apply in one click
Upload My Resume
Drop here or click to browse · Tap to choose · PDF, DOCX, DOC, RTF, TXT