Drug Pricing SME

Baltimore, MD

Drug Pricing SME

Category: Business Consulting, Strategy and Digital Transformation

Main location: United States, Remote

Alternate Location(s): United States, Maryland, Baltimore

Position ID: J0324-0617

Employment Type: Full Time

Position Description:

CGI Federal is among the largest IT and business consulting firms in the world, and as member of CGI Federal you will have the opportunity to participate in major IT transformation initiatives and become a shareholder in our 90,000-member strong organization spanning 40 countries. If you’re looking for a challenge that stretches your talents, grows your skills, and takes digital transformation to the next level, CGI is a great place for you. Reach your full potential thanks to training opportunities, mentoring, and coaching, as well as ongoing recognition and feedback programs that will help you grow your career and network.

CGI Federal is seeking a Drug Pricing SME that will report to the CGI Federal Health and Social Services business unit and will assist strategic initiatives for the CMS IRA program.

Our benefits include a share purchase plan, a profit-sharing program, wellness credits, and flexible schedules that promote excellent work-life balance.

Candidates within a 50 miles radius of a CGI Federal office will have to report to the office 2 days per week

Your future duties and responsibilities:

• Devise and implement prescription drug pricing and payer coverage contracting strategies to meet the legislative drug price reduction mandates of the Inflation Reduction Act (IRA) of 2022.

• Collaborate with experts and business leaders, leading both quantitative and qualitative pricing/contracting analyses to support the drug pricing/rebate ecosystem.

• Collect, analyze, and integrate cross-functional information from various sources to aid in scenario-planning and customer insight generation.

• Understand the U.S. healthcare market, Medicare Part B and Part D processes, data flows, and pharmacy reimbursement processes.

• Collect, analyze, and validate Part D and Part B claims for negotiated drugs and identify reimbursements / rebates related to negotiated Maximum Fair Price (MFP).

• Work closely with other domain SMEs to build a business architecture model that aligns with and expands the IRA drug pricing mandates and metric objectives.

• Bring thought leadership to implementing improvements to better manage/track claims and reimbursements across entire ecosystem.

• Regularly engage with senior leadership to translate strategy into action.

• Communicate results in a timely manner through disciplined management and performance measurement.

Required qualifications to be successful in this role:

• Bachelor’s degree or advanced degree from an accredited institution or an equivalent number of credits in pharmacy, business, economics, budget, management, computer science.

• Experience: 5+ years in a related field.

• 5-10 years of experience with work directly related to drug pricing patterns and their relationship to economic trends.

• Direct experience leading and implementing pharmacy programs, specifically Medicare Prescription Part B and Part D Drug Program.

• Knowledge and experience with Medicare and the pharmaceutical/drug supply chain.

• In-depth understanding of the current relationships and interactions between drug manufacturers, wholesalers, plan administrators/plans, PBMs, pharmacies/other dispensing entities, and beneficiaries.

• Experience with processing and validating claims from dispensers for selected drugs with an MFP (such as confirming the NDC/HCPCS for the selected drug, confirming the dispenser, checking for duplicates, checking for 340B status, checking for claims adjustments, and other validation exercises)

• Proven ability to combine vision, creativity, and innovation to solve problems with strong business acumen, well-developed management, and leadership qualities.

• Ability to interpret policy and propose business solutions/initiatives related to the Inflation Reduction Act of 2022 and interpret the IRA requirements for implementation.

• Ability to develop and perform quality assurance and validation exercises related to Part B and Part D IRA drug pricing and rebates activities to encompass drug manufacturer, wholesaler, PBM, dispenser, TPA, and health plans ecosystem.

• Experience using a managed care claims processing application (e.g., Modeln) is a plus.

• PMP Certification is a plus.

• Excellent communication and collaboration skills to work with various stakeholders, teams, sponsors, members, vendors, senior management, providers, and pharmacists.

• Strong analytical problem-solving skills and excellent interpersonal skills.

• Ability to effectively communicate both verbally and in writing with customers, team members, and management.

• Proactive and self-starting, with the ability to work independently and in a team environment.

• Exceptional attention to detail.

CGI is required by law in some jurisdictions to include a reasonable estimate of the compensation range for this role. The determination of this range includes various factors not limited to: skill set level; experience and training; and licensure and certifications. CGI typically does not hire individuals at or near the top of the range for their role. Compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $106,200 - $185,800.

CGI Federal anticipates accepting applications for this position through 5/31/2024.

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Skills:

  • Business Process Analysis

  • Use Case Development

What you can expect from us:

Together, as owners, let’s turn meaningful insights into action.

Life at CGI is rooted in ownership, teamwork, respect and belonging. Here, you’ll reach your full potential because…

You are invited to be an owner from day 1 as we work together to bring our Dream to life. That’s why we call ourselves CGI Partners rather than employees. We benefit from our collective success and actively shape our company’s strategy and direction.

Your work creates value. You’ll develop innovative solutions and build relationships with teammates and clients while accessing global capabilities to scale your ideas, embrace new opportunities, and benefit from expansive industry and technology expertise.

You’ll shape your career by joining a company built to grow and last. You’ll be supported by leaders who care about your health and well-being and provide you with opportunities to deepen your skills and broaden your horizons.

Come join our team—one of the largest IT and business consulting services firms in the world.

Qualified applicants will receive consideration for employment without regard to their race, ethnicity, ancestry, color, sex, religion, creed, age, national origin, citizenship status, disability, medical condition, military and veteran status, marital status, sexual orientation or perceived sexual orientation, gender, gender identity, and gender expression, familial status, political affiliation, genetic information, or any other legally protected status or characteristics.

CGI provides reasonable accommodations to qualified individuals with disabilities. If you need an accommodation to apply for a job in the U.S., please email the CGI U.S. Employment Compliance mailbox at USEmploymentCompliance@cgi.com . You will need to reference the requisition number of the position in which you are interested. Your message will be routed to the appropriate recruiter who will assist you. Please note, this email address is only to be used for those individuals who need an accommodation to apply for a job. Emails for any other reason or those that do not include a requisition number will not be returned .

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All CGI offers of employment in the U.S. are contingent upon the ability to successfully complete a background investigation. Background investigation components can vary dependent upon specific assignment and/or level of US government security clearance held.

CGI will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with CGI’s legal duty to furnish information.