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Managed Care Analyst III
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Full-time
- This position works with the Teva Market Access account managers and the contracted account to gain alignment on formulary product placement and compliance and to recover previously paid rebate or discounts in the event of noncompliant formulary findings.
- Reporting to the Manager, Contract Compliance, the incumbent will be responsible for identifying and investigating formulary positions on PBM and Health Plan websites and formal Pharmacy Drug Lists (PDL) to validate product placement complies with all terms and conditions of the managed care contract.
- In addition, the Sr. Contract Compliance Analyst will participate in identifying and recommending contracting strategy changes as it relates to the effectiveness of the contract terms and conditions.
- Establishes audit plan to review top 80% of contracted account formularies across commercial, Medicare Part D, and managed Medicaid channels.
- Thorough understanding of Managed Care contracting as it relates to formulary access and tier position; Industry understanding of step-edits, NDC blocks, prior authorizations, copay differentials, preferred and non-preferred status is a plus.
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