Director Patient Health Services

Address: USA-MA-Quincy-1385 Hancock Street
Store Code: Patient Health Services (2760969)
Ahold Delhaize USA, a division of global food retailer Ahold Delhaize, is part of the U.S. family of brands, which includes five leading omnichannel grocery brands - Food Lion, Giant Food, The GIANT Company, Hannaford and Stop & Shop. Our associates support the brands with a wide range of services, including Finance, Legal, Sustainability, Commercial, Digital and E-commerce, Technology and more.
Patient Health Services Director provides strategic leadership as well as financial and administrative oversight of Managed Care payer network negotiations, contracting, payment & reconciliation and financial analysis with Commercial and Government (Medicare and Medicaid) entities. This role collaborates with Brands in the identification of national and regional pharmacy plan sponsors (health plans, employers, etc.) and advocates and promotes Brand pharmacies for inclusion within these pharmacy networks. Provides strategic recommendations to brands on participation in networks based on industry insight and financial implications that align with brand strategies. Leads the payments and reconciliation area to lead third party pharmacy receivables (collections, rebilling, research and all other related activities).
Our flexible/ hybrid work schedule includes 3 in-person days at one of our core locations and 2 remote days. Our core office locations include Quincy, MA, Carlisle, PA, Scarborough.
Essential job functions:

• Establishes and maintains relationships with Pharmacy Benefit Managers, Health Plan Sponsors, Large Employer Groups, and other payers who sponsor retail pharmacy networks.
• Develops organizational Managed Care contracting policies and objectives that deliver against Brand strategies and financial objectives.
• Leads a team responsible for payer contracting activities, including contract financial analysis, negotiations, network targeting, contract management, and performance management.
• Delivers conclusive recommendations to Brand leadership regarding their participation or non-participation within new or existing payer networks based upon financial analysis of proposed contract terms, reimbursement, and volume projections.
• Provides guidance to Brand pharmacies regarding Governmental payer program compliance standards.
• Leads a team responsible for managed care payment reconciliation, manual billing, and other pharmacy receivables activities. Establishes communication pathways for sharing data and recommendations with the brands on financial outcomes from existing processes. Utilizes strategic thinking and partnership behaviors to establish new processes delivering streamlined, efficient and financial improvements.
• Provides brand pharmacy leadership with outcomes measurements of clinical programsand overall reimbursement performance
• Leads periodic analysis of all clinical and customer facing programs deployed by Brand pharmacies, assessing the economic viability and performance impact of each through periodic reporting, maintenance and communication of key metrics.
• Additional job duties may be assigned as needed to meet the needs of the business and support our Values.

Qualifications:

• Bachelor's Degree
• 5+ years relevant pharmacy experience
• 5+ years leading teams
• 3+ years contract negotiation skills
• Ability to lead executive level presentations
• Ability to have strategic decision making
• Strong change management skills with the ability to guide teams through transitions, implement new processes, and ensure smooth adaptation to organizational changes.
• Applicants must be currently authorized to work in the United States on a full-time basis until the end of their appointment

Preferred Qualifications:

• MBA in healthcare related field

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At Ahold Delhaize USA, we provide services to one of the largest portfolios of grocery companies in the nation, and we're actively seeking top talent. Our team shares a common motivation to drive change, take ownership and enable our brands to better care for their customers. We thrive on supporting great local grocery brands and their strategies.
We offer an experience where our associates are valued; Diversity, Equity, Inclusion and Belonging are infused in our business and our employees are representative of the communities that we serve. We believe in total wellness, which encompasses a blend of physical, financial and emotional wellness.
We believe in collaboration, curiosity, and continuous learning in all that we think, create and do. While building a culture where personal and professional growth are just as important as business growth, we invest in our people, empowering them to learn, grow and deliver at all levels of the business.
Job Requisition: 396615_external_USA-MA-Quincy