Drug Pricing SME




United States (Remote)

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    Position summary

    urchase 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.


    Insights you can act on

    While technology is at the heart of our clients' digital transformation, we understand that people are at the heart of business success.

    When you join CGI, you become a trusted advisor, collaborating with colleagues and clients to bring forward actionable insights that deliver meaningful and sustainable outcomes. We call our employees "members" because they are CGI shareholders and owners and owners who enjoy working and growing together to build a company we are proud of. This has been our Dream since 1976, and it has brought us to where we are today - one of the world's largest independent providers of IT and business consulting services.

    At CGI, we recognize the richness that diversity brings. We strive to create a work culture where all belong and collaborate with clients in building more inclusive communities. As an equal-opportunity employer, we want to empower all our members to succeed and grow. If you require an accommodation at any point during the recruitment process, please let us know. We will be happy to assist.

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    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.

    Why you should apply for a job to CGI:

  • 59% say the CEO supports gender diversity
  • Ratings are based on anonymous reviews by Fairygodboss members.
  • We offer our employees great flexible working options all over the world
  • Thanks to our members, we've been named a #TopWorkplace by the Washington Post again in 2021
  • Forbes Names CGI one of America's Best Management Consulting Firms