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Pharmacy Benefits Plan Consulting Manager

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Deloitte

Jan 12, 2025

  • Job
    Full-time
    Senior & Expert Level
  • Consulting
    Healthcare
  • Pleasanton

AI generated summary

  • You need a Bachelor's, 8+ years in health plan consulting, financial projections experience, healthcare finance knowledge, and proficiency in MS Office. Travel and U.S. work authorization required.
  • You will lead pharmacy benefits studies, analyze vendors, design plans, negotiate rates, prepare financial projections, review health performance, and create client presentations and reports.

Requirements

  • Bachelor's Degree
  • 8+ years' experience in employer health plan consulting
  • 1+ years experience reviewing health plan performance
  • 1+ years experience preparing financial/budget projections
  • Proficiency with MS Office products, including Word, Excel, PowerPoint
  • Must be able to obtain and maintain the required clearance for this role
  • Ability to travel 25-50%, on average, based on the work you do and the clients and industries/sectors you serve
  • Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future
  • Prior professional services or federal consulting experience
  • 14+ years of health plan/insurance/pharmaceutical company and/or consulting experience
  • Technical background in underwriting and other areas of health care finance
  • Strong understanding of health care plan design and alternative delivery systems, including consumer directed health plans with HRAs and HSAs
  • Knowledge (plan design and pricing) of other health & welfare benefit plans (e.g., life, disability, dental, etc.)
  • Technical background in underwriting and other areas of health care finance
  • CEBS Designation or Actuarial credentials
  • In-depth experience with healthcare and pharmacy benefit management, including:
  • Experience performing vendor selection reviews for Self-insured Health plans administrators and PBMs
  • Experience performing hospital / physician network discount and network disruption analyses
  • Experience with evaluating the pricing arrangements for PBMs contracts, including evaluation of disruption related to formulary changes
  • Experience reviewing and negotiating pharmacy contracts (pricing and business terms) with PBMS
  • Experience performing analytical analysis of medical & pharmacy claims, including understanding financial impact of network changes, design changes and formulary changes
  • Understanding of healthcare landscape, including up and coming trends in medical and pharmacy

Responsibilities

  • Lead employee benefits diagnostic/planning studies, especially in pharmacy
  • Provide subject matter expertise on the pharmacy landscape, including emerging trends and cost drivers
  • Work directly with medical and PBM vendors to analyze the program offering and cost management solutions
  • Own the process of preparing benefits plan design and pricing studies
  • Implement competitive vendor search and selection initiatives
  • Review of health plan renewals including assisting in rate negotiation, and analyzing financial terms for both medical and pharmacy
  • Prepare financial projections and rate development
  • Review health plan performance, including reviewing policy year settlements and premium rate/administrative fee renewals
  • Prepare client presentations and reports
  • Conduct other general health & welfare consulting activities, as required
  • In addition to serving plan sponsors, other project work can include working with payers and providers in such projects as provider network development, operational claim reviews, etc.

FAQs

What is the primary focus of the Pharmacy Benefits Plan Consulting Manager role?

The primary focus of the Pharmacy Benefits Plan Consulting Manager role is to lead employee benefits diagnostic/planning studies specifically in pharmacy, providing subject matter expertise on the pharmacy landscape and cost management solutions.

What qualifications are required for this position?

Required qualifications include a Bachelor's Degree, 8+ years of experience in employer health plan consulting, experience in reviewing health plan performance and preparing financial projections, proficiency with MS Office products, and the ability to obtain necessary clearance for the role.

Is travel required for this position, and if so, how much?

Yes, travel is required for this position, with an expectation of 25-50% travel based on the work you do and the clients you serve.

What experience is preferred for candidates applying for this role?

Preferred experience includes 14+ years of health plan/insurance/pharmaceutical company and/or consulting experience, prior professional services or federal consulting experience, and a technical background in underwriting and healthcare finance.

Are there any specific certifications that are preferred for candidates?

Yes, preferred certifications include the CEBS Designation or Actuarial credentials.

What type of consulting activities will this role involve?

The role will involve activities such as conducting employee benefits studies, analyzing health plan performance, preparing client presentations and reports, and engaging in general health and welfare consulting tasks.

What is the compensation range for this position in specific states?

The compensation range for this position in states such as California, Colorado, Hawaii, New Jersey, Nevada, New York, and Washington is estimated to be between $131,175 and $218,625.

Are there opportunities for career advancement in this role?

Yes, this role offers opportunities for professional growth and new responsibilities within Deloitte's Human Capital practice.

What kind of team will I be working with in this role?

You will be working with Deloitte's Government and Public Services (GPS) practice, which includes over 15,000 professionals dedicated to delivering impactful services to federal, state, local government clients, and public higher education institutions.

Does Deloitte offer any incentives or bonuses for this position?

Yes, you may be eligible to participate in a discretionary annual incentive program, which depends on individual and organizational performance.

Consulting
Industry
10,001+
Employees
1845
Founded Year

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Deloitte, as one of the Big 4 global professional services firms, offers a comprehensive range of services including audit, tax, consulting, and advisory solutions to clients worldwide. Their ultimate mission is to deliver exceptional value to their clients by helping them navigate complex challenges, achieve sustainable growth, and stay ahead in an ever-changing business landscape. Deloitte's purpose lies in making an impact that matters and contributing to the success and well-being of their clients, people, and communities. With a team of skilled professionals and a commitment to innovation and collaboration, Deloitte strives to shape the future of business and create positive, lasting outcomes for their stakeholders.

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