This is a tremendous opportunity to join Mercer's Government Human Services Consulting (GHSC) practice which focuses on the unique and challenging needs of the public health care sector by providing a wide array of consulting services to local, state, and federal government agencies across the country. GHSC helps clients achieve better outcomes, develop and deploy defensible strategies, and reshape the delivery of health care. We deliver an individualized focus, powered by industry-leading experience, integrated capabilities and passionate people. GHSC has been partnering with states and other stakeholder organizations for over 34 years to face the demands and pace of change with data‑driven pricing, clinically-informed policy and trusted, reliable strategies to manage and deliver care.
To accomplish these challenging and exciting tasks, GHSC brings together a team of highly-skilled and dedicated consultants, clinicians, actuaries, analysts, accountants and pharmacists from across the country. To learn more about Mercer's GHSC practice, please visit .
Candidates can be remote or based in the Phoenix, Atlanta or Minneapolis office #LI-REMOTE. .
Senior Government Consultant Pharmacy
What can you expect?
- The Senior Government Pharmacy Consultant will lead the accurate and timely data and financial analysis on large, complex state pharmacy projects
- A significant part of this role is to be a key leader &/or contributor for projects while developing and growing intellectual capital
- Additionally, you are needed to expand existing business and identify new business opportunities
What is in it for you?
- Work for a global industry leader with a dynamic and inclusive culture
- Excellent growth/advancement opportunity
- Make an impact by helping the vulnerable populations through the development of meaningful programs
We will count on you to:
- Manage the day-to-day relationship with the key members of the client team; individually &/or in conjunction with the Senior Client Manager, present on project results to clients, carriers, managed care entities and other related entities
- Work with the Senior Client Manager to initiate the project after a project is sold to the client. This includes meeting with the client and clearly defining the scope, timelines and deliverable of the project. Also you will develop and propose essential project documents, including the strategy, budget and work plans
- Identify and allocate resources, ensuring work is delegated to the appropriate skill and career level, and providing team members opportunity to develop skills and expertise
- Oversee regular team meetings, maintaining project documents and may produce documents stating project results, including reports, charts and analyses,
- Manage data and financial analytical work on large and complex state managed health and welfare capitation projects. These capitation projects are commissioned by government entities to determine the rates that they will pay for health and welfare services covered by their plans
- Work with the client to define the scope of the project; serve as expert on rate structure and methodology; ensure the project is consistent with federal regulations and actuarial standards; determine the appropriate data sources for the specific project's data analysis
- Develop the rate setting assumptions that are built into the data model and informs client and project team on impact of data assumptions; oversee data analysis that is conducted by junior staff members. Provide on-going review and guidance during the data analysis process; review data analysis results for soundness; present client with sub analyses throughout project cycle
- Draft project communications, including rate capitation letters; act as actuarial authority that signs and certifies rate capitation letters
What you need to have:
- BS degree required; additional advanced degree preferred (MPA, JD, MBA)
- Minimum 10 years of relevant experience
- Managed Medicaid or State Medicaid experience required
What makes you stand out:
- PharmD strongly preferred
- Pharmacy benefit management experience preferred
- Managed care and/or health plan knowledge preferred
- Excellent project management and interpersonal skills; strong oral and written communication skills
- Strong knowledge of pharmacy claim payment systems
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