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Role Summary

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HIGHLIGHTS

Executive health actuarial leadership role overseeing pharmacy actuarial strategy for Medicare Part D, Medicaid, MMP/SNP and Commercial Exchange across the US. Responsible for pharmacy pricing, trend analysis, CMS Part D bid development, forecasting, rebate evaluation and drug cost management. Manages a pharmacy actuarial team and advises senior finance and pharmacy leadership. Flexible work options with remote/hybrid scheduling.

JOB DESCRIPTION SUMMARY

  • Lead enterprise pharmacy actuarial strategy across Medicare Part D, Medicaid, MMP/SNP and Exchange
  • Oversee pricing models, trend analytics, drug-mix analysis and total cost forecasting
  • Direct CMS Part D bid development including PDE forecasting and DIR assumptions
  • Manage and develop a team of pharmacy actuaries and analysts
  • Partner with PBMs, clinical pharmacy, finance and product leadership

DOMAIN EXPERTISE

  • Medicare Part D pharmacy actuarial experience
  • Medicaid pharmacy actuarial experience
  • Commercial pharmacy actuarial experience
  • Experience working with PBMs or PBM-integrated environments
  • CMS Part D bid development and PDE/DIR reconciliation

KEY REQUIREMENTS

  • 15+ years of progressively responsible actuarial experience with pharmacy focus
  • Pharmacy actuarial experience across Medicare Part D, Medicaid and/or Commercial plans
  • 3–5 years in executive or senior leadership roles
  • Bachelor’s degree in Actuarial Science, Mathematics, Statistics or related field
  • Experience with CMS Part D bid development and PDE/DIR processes

TECH STACK

  • Excel
  • PowerPoint
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Role Summary

Loading...

HIGHLIGHTS

Executive health actuarial leadership role overseeing pharmacy actuarial strategy for Medicare Part D, Medicaid, MMP/SNP and Commercial Exchange across the US. Responsible for pharmacy pricing, trend analysis, CMS Part D bid development, forecasting, rebate evaluation and drug cost management. Manages a pharmacy actuarial team and advises senior finance and pharmacy leadership. Flexible work options with remote/hybrid scheduling.

JOB DESCRIPTION SUMMARY

  • Lead enterprise pharmacy actuarial strategy across Medicare Part D, Medicaid, MMP/SNP and Exchange
  • Oversee pricing models, trend analytics, drug-mix analysis and total cost forecasting
  • Direct CMS Part D bid development including PDE forecasting and DIR assumptions
  • Manage and develop a team of pharmacy actuaries and analysts
  • Partner with PBMs, clinical pharmacy, finance and product leadership

DOMAIN EXPERTISE

  • Medicare Part D pharmacy actuarial experience
  • Medicaid pharmacy actuarial experience
  • Commercial pharmacy actuarial experience
  • Experience working with PBMs or PBM-integrated environments
  • CMS Part D bid development and PDE/DIR reconciliation

KEY REQUIREMENTS

  • 15+ years of progressively responsible actuarial experience with pharmacy focus
  • Pharmacy actuarial experience across Medicare Part D, Medicaid and/or Commercial plans
  • 3–5 years in executive or senior leadership roles
  • Bachelor’s degree in Actuarial Science, Mathematics, Statistics or related field
  • Experience with CMS Part D bid development and PDE/DIR processes

TECH STACK

  • Excel
  • PowerPoint

Job Overview

Salary
Salary not specified
Years of Experience
15+ Years
Work Type
Permanent
Full Time

Ideal Candidate Profile

Ideal for an executive-level health actuary with 15+ years of pharmacy-focused experience across Medicare Part D, Medicaid and commercial plans, strong CMS bid and pricing expertise, and proven ability to lead teams and partner with PBMs and finance.

Benefits

Hybrid WorkHealth Insurance401(k) PlanGenerous VacationTuition ReimbursementVolunteering Program
Shortlist Forming
Closing Soon
28d
28 days ago

Strategy: Speed over Perfection

By Day 21, visibility drops significantly. Recruiters are focusing on existing candidates.

"Don't wait for a cover letter. The requisition could close tomorrow. Apply now."

Job Overview

Salary
Salary not specified
Years of Experience
15+ Years
Work Type
Permanent
Full Time

Ideal Candidate Profile

Ideal for an executive-level health actuary with 15+ years of pharmacy-focused experience across Medicare Part D, Medicaid and commercial plans, strong CMS bid and pricing expertise, and proven ability to lead teams and partner with PBMs and finance.

Benefits

Hybrid WorkHealth Insurance401(k) PlanGenerous VacationTuition ReimbursementVolunteering Program
Shortlist Forming
Closing Soon
28d
28 days ago

Strategy: Speed over Perfection

By Day 21, visibility drops significantly. Recruiters are focusing on existing candidates.

"Don't wait for a cover letter. The requisition could close tomorrow. Apply now."

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