Manager, Payor Operations and Solutions

Job Summary

Responsible for leading and directing activities associated with the operations, implementation and maintenance of executed contracts for third party programs (e.g. retail pharmacy, mail service, specialty pharmacy, infusion, take care retail clinics). Works cross-functionally (e.g. Sales, Store Operations, Marketing, Purchasing, Advertising, Information Technology, Accounting, Finance, Logistics, Distribution and Law) to coordinate contract administration for pharmacy and medical benefit programs including processing, billing, reimbursement, formulary and payment information. Ensures that policies and procedures are revised and implemented to address any operational issues that are identified on the Walgreens side. Knowledge and understanding of products and services, store/field operations and contracts as well as knowledge of the managed care and insurance industries and their respective business issues and potential opportunities.

Job Responsibilities

• Partners with the management team to identify, develop, and implement appropriate approaches, processes, and tools that elevate the analytics group.
• Monitors the contract terms and commitments to assure all deliverables are adhered to and take proactive measures before key milestones are missed. Monitors the implementation process for all third party programs, while balancing client needs and company objectives to ensure a successful/positive implementation for both parties. Ensures maximum gross sales and profit by working closely with Contracting Directors/Managers through the ongoing review and confirmation of any non-standard third party plan setup requests. Works with corporate and field on any reimbursement issues, and brings exceptions or non-standard requests to the attention of senior management where appropriate. Maintains communication regarding third party participation, contract compliance, and any other operational issues or opportunities.
• Manages the tracking, approval, administration, and post-implementation process of all Managed Care contracts throughout the contract life cycle.
• Works with Contracting Directors/Managers to review Third Party Managed Care Contracts to ensure operational requirements can be met and implemented.
• Monitors the technical links between the Third Party Provider and data tracking systems to assure reported issues are properly captured, reported, prioritized and managed to closure.
• Oversees a Third Party Governance Process including periodic status calls, quarterly performance reviews, annual business planning, change order reviews and Third Party budgets/ costs. Conducts periodic meetings/ calls with internal departments to address administration issues, and coordinates resolution with the Service Provider as required.
• Trains and provides ongoing education to personnel, customers, contractors, etc. on processes and procedures to address Payor related issues, updates, and opportunities. Works with appropriate internal and external parties to load and update new/existing location, market, and provider information.
• Manages and audits the loading and updates of pricing and reimbursement terms to ensure contract compliance and appropriate profit and reimbursement.
• Creates and oversees the training schedule of new employees as well as participate in a significant amount of training for new and existing employees. Provides analytical guidance, mentoring, and coaching to the team and peers.

About Walgreens

Founded in 1901, Walgreens ( proudly serves nearly 9 million customers and patients each day across its approximately 8,500 stores throughout the U.S. and Puerto Rico. Walgreens has approximately 220,000 team members, including nearly 90,000 healthcare service providers, and is committed to being the first choice for pharmacy, retail and health services, building trusted relationships that create healthier futures for customers, patients, team members and communities.

Basic Qualifications

• Bachelor's degree and at least 2 years of experience in healthcare industry OR High School Diploma / GED and at least 4 years of experience in healthcare industry.
• At least two (2) years’ experience in performing a combination of analysis, administration, or operations in the healthcare industry.
• Experience collaborating with internal and resources to develop strategies that meet department goals within budget and established timelines.
• Experience with analyzing and reporting data in order to identify issues, trends, or exceptions to drive improvement of results and find solutions.
• Experience in identifying operational issues and recommending and implementing strategies to resolve problems.
• Advanced level skill in Microsoft Excel (for example: using AVERAGE function, merging and centering cells, printing centered page and/or creating a pivot table).
• Intermediate level skill in Microsoft Word (for example: creating and modifying text styles, numbering and sorting lists, working with sections and columns, formatting tables, and using templates and using diagrams and drawing tools)
• Intermediate level skill in Microsoft PowerPoint (for example: creating presentations, adding and removing slides, entering and formatting text, applying design templates, modifying masters, inserting graphics and objects, creating handouts).
• At least 1 year of project management
• At least 1 year of direct leadership, indirect leadership and/or cross-functional team leadership.
• Willing to travel up to/at least 15% of the time for business purposes (within state and out of state).

Preferred Qualifications

• MBA
• At least two (2) years’ experience implementing contracted Third Party programs in the healthcare industry.
• At least two (2) years’ experience administering healthcare contracts.
• At least two (2) years Payor and facility credentialing experience.
• At least two (2) years medical reimbursement/fee schedule maintenance experience.
• Infusion, Specialty Pharmacy, Retail Clinic, and/or Pharmacy Technician experience.
• Experience using Walgreen proprietary systems (e.g. AS400, SIMS, POS, IC+)
• At least 2 years experience working in retail pharmacy operations.
• At least 2 years working collaboratively with cross-functional teams.
• Experience in identifying operational issues and recommending and implementing strategies to resolve problems. This would include using business and analytical skills to facilitate requirement sessions and documenting activity workflows and business requirements. Such process would involve experience in the direct and indirect management of team members, including assisting in the development, training and assignment of work/projects to other team members.

We will consider employment of qualified applicants with arrest and conviction records.

The Salary below is being provided to promote pay transparency and equal employment opportunities at Walgreens. The actual hourly salary within this range that you will be offered will depend on a variety of factors including geography, skills and abilities, education, experience and other relevant factors. This role will remain open until filled. To review benefits, please click here jobs.walgreens.com/benefits. If you are applying on a job board or unable to click on the link, please copy and paste this URL into your browser jobs.walgreens.com/benefits

Salary Range: $102800 - $164400 / Salaried