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Evolent Health Product Manager, Medical Drug in Boston, Massachusetts

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Evolenteers make a difference wherever they are, whether it is at a medical center, in the office, or while working from home across 48 states. We empower you to work from where you work best, which makes juggling careers, families, and social lives so much easier. Through our recognition programs, we also highlight employees who live our values, give back to our communities each year, and are champions for bringing their whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

Why We’re Worth the Application:

  • We continue to grow year over year.

  • Recognized as a leader in driving important diversity, equity, and inclusion (DE&I) efforts (https://www.evolenthealth.com/diversity) .

  • Achieved a 100% score two years in a row on the Human Rights Campaign's Corporate Equality Index making us a best place to work for LGBTQ+ equality.

  • Named to Parity.org’s 2020 list of the best companies for women to advance (https://www.evolenthealth.com/about-us/press-releases/8579/evolent-health-named-to-parity.org%E2%80%99s-best-companies-for-women-to-advance-list-2021) .

  • Continued to prioritize the employee experience and achieved an 87% overall engagement score on our last employee survey.

  • Published an annual DE&I report (https://dev.evolenthealth.com/sites/default/files-public/Evolent%20Health%202020%20DE%26I%20Annual%20Report.pdf) to share our progress on how we’re building an equitable workplace.

What You’ll Be Doing:

The Role

Evolent Health is looking for a Product Manager to be a key member of the Pharmacy Services team. This individual will play a critical role in executing Evolent Health’s mission by serving as a manager of medical drug products. The Evolent Health Pharmacy team has responsibilities pertaining to management of both medical and pharmacy drug coverage across multiple lines of business (Commercial, Exchange, Medicare, and Medicaid). The Product Manager will be a primary contributor to the operational and strategic aspects of the medical drug management product. We are looking for a team member with high energy, a strong work ethic, integrity, who is kind and empathetic, has a sense of humor, and enjoys working for a collaborative, team-oriented company.

Responsibilities

Medical Drug List Management and Program Development

  • Manage a list of covered biosimilar and originator medical drug products that includes HCPCS and NDC code information along with any plan limitations, such as prior authorization or quantity limitations

  • Contribute to the development of new and existing preferred medical drug product programs in collaboration with clinical pharmacists considering both lowest net cost and clinical effectiveness in decision making

  • Support provider education of preferred drug list coverage by creating content for newsletters, emails, fax blasts, site visits, etc.

  • Enhancement and maintenance of medical drug site of care programs

Medical Drug Rebate Administration

  • Aggregate rebate contracts from a 3rd party administrator

  • Submit quarterly medical drug claim extracts for rebate invoicing

  • Create and provide a quarterly client level rebate invoice report

  • Assess rebate performance

  • Conduct rebate payment quality checks

Client Engagement

  • Set-up recurrent client meetings and develop meeting agendas and content

  • Manage ad hoc requests for reporting or program enhancements

  • Establish client relationship and promote pharmacy program opportunities

  • Present information during meetings, including operational reports and new initiatives

Medical Drug Processing

  • Develop and implement enhanced coverage rules for medical drug claim processing (e.g., smart rules with overrides based on ICD 10 codes and gold-carding programs)

  • Evaluate and implement auto-authorization opportunities for utilization management reviews

  • Analyze medical drug claims for payment integrity (e.g., obsolete NDCs, age/gender, quantity limits, etc.)

  • Work with medical drug technical domain lead(s) to optimize medical drug claim edits and reimbursement

Preferred Experience We Look for:

  • Bachelor’s degree

  • At least 3 years of experience managing medical drug products and/or medical drug claims processing

  • Experience in Pharmacy Benefit Management (PBM)

  • Client-facing experience

  • Ability to lead, organize and monitor projects

  • Excellent written and verbal communication skills

Skills and Behavioral Attributes

  • Ability to make independent decisions

  • Committed to team-oriented work environment

  • Exceptional interpersonal, presentation, oral and written communication skills

  • Strong work ethic built on a foundation of proactivity

  • Committed to the practice of inquiry and listening

  • Navigate ambiguity with structured problem-solving and decision-making

  • Analytic with the ability to transform data & trends into actionable insight

Technical Requirements:

Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

Evolent Health is committed to the safety and wellbeing of all its employees, partners and patients and complies with all applicable local, state, and federal law regarding COVID health and vaccination requirements. Evolent expects all employees to also comply. We currently require all employees who may voluntarily return to our Evolent offices to be vaccinated and invite all employees regardless of vaccination status to remain working from home. Certain jobs require face-to-face interaction with our providers and patients in client facilities or homes. Employees working in such roles will be required to meet our vaccine requirements without exception or exemption.

Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.

Compensation Range: The minimum salary for this position is $90000, plus benefits. Salaries are determined by the skill set required for the position and commensurate with experience and may vary above and below the stated amounts.

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