Director – Networks and Underwriting

This is a fully remote position, open to applicants in United States.

📋 Description

• Direct TrueScripts’ strategy for pharmacy networks, performance management, contracting strategies, and optimization of the network.

• Assess network alternatives and identify suitable network frameworks for various client demographics and market segments.

• Set network performance goals and track network economics, accessibility, competitiveness, and the effects on clients.

• Examine trends in pharmacy reimbursement, market conditions, competitive landscapes, and pharmacy economics.

• Supervise the creation and enhancement of PBM underwriting methodologies.

• Manage financial modeling for new business initiatives, renewals, and opportunities with existing clients.

• Define assumptions regarding pharmacy usage, drug combinations, reimbursement rates, discounts, rebates, dispensing fees, trends, and other financial factors.

• Assess financial risks, margin potentials, pricing strategies, and underwriting assumptions.

• Oversee contractual guarantees concerning network discounts, ingredient costs, rebates, trends, pricing, and other PBM obligations.

• Track guarantee performance and suggest corrective actions for any discrepancies.

• Assist in new business and renewal efforts, RFPs, proposals, negotiations, and deal structuring decisions.

• Provide strategic guidance on pharmacy reimbursement, contracting strategies, acquisition costs, MAC pricing, ingredient pricing, and dispensing fees.

• Create dashboards, reports, KPIs, executive-level analyses, and actionable insights.

• Collaborate across functions with Finance, Sales, Client Services, Clinical, Operations, Data & Analytics, and Executive Leadership.

• Lead, develop, and mentor members of the Network and Underwriting teams.

• Set objectives, ensure accountability, establish succession plans, standardize processes, and maintain documentation.

⛳️ Requirements

• Bachelor's degree in Accounting, Finance, Business, Healthcare Administration, Compliance, or a related field in Business, Finance, Economics, Healthcare Administration, Pharmacy, or similar disciplines.

• Over 7 years of progressive experience in PBM, pharmacy benefits, healthcare, underwriting, network management, pricing, or related fields.

• Proven experience with PBM financial modeling and underwriting processes.

• Strong grasp of pharmacy network economics and reimbursement methodologies.

• Familiarity with PBM pricing, guarantees, rebates, discounts, and financial obligations.

• Excellent analytical and financial modeling capabilities.

• Demonstrated success in leading cross-functional projects and influencing decisions at the executive level.

• Strong understanding of pharmacy claims and utilization metrics.

• Exceptional communication, negotiation, and presentation abilities.

• Primarily a remote role with occasional travel required to the TrueScripts office in Washington, Indiana.

• Travel is expected to be less than 10%.

🏝️ Benefits

• A comprehensive selection of health insurance options, including medical, dental, and vision coverage.

• A competitive salary along with a bonus program.

• An extensive 401k plan with company matching contributions.

• Participation in an Employee Stock Ownership Plan (ESOP) with annual allocations of company stock.

• A flexible working environment.

• A 5-star wellness program offering financial incentives, chiropractic and massage services, and fitness stipends.

• Access to the Dream Manager Program.

• A supportive, family-oriented culture.

• Opportunities for charitable contributions and volunteer time.