What you’ll do 

In a few words…

Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…   

As the Director of Client Engagement, you’ll be responsible for oversight of Client relationships for US based accounts. Lead a team of professionals whose overall focus is to ensure the highest quality of customer service and expansion of existing business. As Director you’ll also work closely with the VP of Client Success to determine strategies to provide the ultimate client service and strict operational compliance with all client contracts and regulatory requirements.

 The fundamentals for the job…

• Establish and maintain multi-level relationships with key clients and identify business expansion opportunities and strategies.
• Able to navigate and contribute to complex operational day-to-day functions and serve as the main point of escalation. 
• Lead Account Executives in providing superior client service. Be a voice for the Clients and the team with internal partners.
• Enhance and build relationships with key decision makers at the Client to better understand the value of working with Abarca Health
• Ensure that clients relationships, needs, and requests are managed in a timely and high-quality manner.
• Own coordination and delivery of business reviews to the Clients.
• Track and provide visibility internally and with clients around meeting client deliverables (SLAs, overall goals, service requests).
• Understand challenges, discuss internally, and identify solutions in a consultative matter.
• Develop annual business plans and manages the monthly, quarterly, and annual performance to achieve targets while ensuring compliance with all applicable laws, regulations, policies, and procedures.
• Work with the VP of Client Success to develop and maintain a portfolio of improvement opportunities including technology-based solutions. Build business cases and sell his/her ideas to impacted and influential stakeholders.
• Lead, mentor, and provide growth and development to direct reports. Upgrade talent when and where necessary.
• Collaborate with cross-functional teams to execute projects and to deliver the highest quality of service for all clients and partners.
• Support sales efforts as a representative of the Client Team, client PBM related initiatives and other initiatives as assigned.

What we expect of you

The bold requirements…

• Bachelor 's Degree or Master’s Degree in a related area. (In lieu of a degree, equivalent relevant work experience may be considered.)
• 10+ years of experience in Medicare Operations, Client Management, Pharmaceutical Management, Project Management, or other related experience
• Experience with PBM Operations, Member Services, Pharmacy Networks, Fulfillment, Call Center, and Medicare Part D.
• Experience in presenting to clients, partners, internal stakeholders, and other audiences within the industry.
• Excellent oral and written communication skills.
• We are proud to offer a flexible hybrid work model which will require certain on-site workdays (Puerto Rico Location Only) This position requires availability to work in a specified time zone or working schedule, accommodating the business needs of our clients and team members.
• This position may require availability for on-call hours, including evenings, weekends, and holidays, to promptly address emergent issues or provide necessary support as dictated by operational demands (if applicable).

Physical requirements…

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves.  We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify.  “Abarca Health LLC does not sponsor employment visas at this time”

The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.

#LI-REMOTE #LI-JD

What you’ll do

In a few words…

Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…

As our Regulatory Analyst, you will be responsible for ensuring that business operations and procedures are compliant with all state and federal regulatory requirements and abide by State Medicaid Plans as applicable to Abarca. You will ensure that business owners receive, understand, and abide by all federal and state regulations. You will be an independent and critical thinker, and an effective communicator. It is important that you are always up to speed on all regulations applicable to Abarca operations and delegated services.

In this position you will support the Regulatory Compliance Team, in executing Abarca’s Regulatory Change Management Process, including regulatory trainings, Policies & Procedures management, and regulatory consults. You will perform a range of duties such as evaluating compliance regulations and guidance, supporting operational areas in the implementation and documentation of new requirements, and researching and responding to regulatory consults. You will also be responsible for acting as a consultative figure to our clients on regulatory topics, addressing possible changes to delegated services and regulatory questions stemming from potential audit concerns. 

The fundamentals for the job…

• Stay abreast of all regulatory requirements and legislation, industry trends, and best practices.
• Keep track of regulatory changes for Commercial, Medicare and/or Medicaid, as assigned, including State Medicaid requirements for those states in which Abarca processes claims.
• Monitor regulatory changes and assess any potential impact of these changes in Abarca’s processes.
• Work with business areas to discuss identified changes in regulation, define required actions, and ensure requirements are implemented as appropriate.
• Participate in the Regulatory Change Management (RCM) Committee meetings, presenting regulatory updates and engaging participation of subject matter experts (SME’s).
• Prepare Compliance Updates and summaries of regulatory requirements identifying required actions, for internal and external stakeholders and maintaining updated Abarca’s regulatory log.
• Work with operational areas to ensure that required actions derived from guidance are completed, including implementation of new processes, updating current processes, and advising on compliant operations, in accordance with applicable due dates.
• Lead Policies and Procedures Management process, creating or reviewing P&P’s and ensuring that P&P’s are reviewed within required frequency, and updated with federal and state regulatory requirements, current operations, and overall business operations.
• Develop a user-friendly system for maintaining the organization’s policies and procedures and ensure they are properly published to the entire organization.
• Implement regular communication methods to keep all employees informed of policy and procedure updates.
• Perform research and review guidance to provide timely responses to regulatory questions from clients and business areas.
• Support the Regulatory Compliance Audits team with regulatory requirements and documentation.
• Support in the development/update of regulatory compliance training materials. Ensure all Abarcans and delegated entities receive new hire and annual regulatory trainings. Develop ad-hoc trainings of regulatory topics as needed.
• Support HIPAA investigations, specifically review and keep track of applicable federal and state requirements, including State Medicaid requirements and Client Business Associate Agreements. Act as liaison with the Security Team when system security issues are involved.
• Maintain and report results on Compliance metrics and assigned Service Level Agreements.

What we expect of you

The bold requirements…

• Bachelor, Law Degree, or Master’s Degree in Health Services Administration, Public Health, Health Evaluation or related field (In lieu of a degree, equivalent, relevant work experience may be considered.)
• 3+ years experience in regulatory management role within healthcare or pharmacy benefit management (PBM) industry.
• Experience with Medicare.
• Strong understanding of industry processes, healthcare regulations, and PBM Operations.
• Excellent oral and written communication skills. 
• We are proud to offer a flexible hybrid work model which will require certain on-site work days (Puerto Rico Location Only).
• This position requires availability to work in a specified time zone or working schedule, accommodating the business needs of our clients and team members.
• This position may require availability for on-call hours, including evenings, weekends, and holidays, to promptly address emergent issues or provide necessary support as dictated by operational demands (if applicable).

Nice to haves…

• Preferred Certification in Healthcare Compliance (CHC), and/or Certified Fraud Examiner (CFE), and/or Certified Internal Auditor (CIA).

Physical requirements… 

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves.  We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify. Abarca Health LLC does not sponsor employment visas at this time.

The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.

#LI-REMOTE #LI-JD1

What you’ll do

In a few words…                                                

Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…

As the Drug Value Strategy Senior Manager, you will be using your coding skills to manage and transform big data into meaningful information and customized solutions for our clients. For this critical role, the best person would be a current coding professional (Python, R, SQL, etc.)  that loves to develop creative solutions and visualizations to effectively and efficiently solve problems and communicate analysis. 

The person in this critical role will be focused on developing the best tools to provide advanced data reporting for our clients.  One area of responsibility for this role is specialty report development.  This includes reporting for the specialty pharmacy network’s current cost saving initiatives and auditing of specialty claims.  This role would also be communicating with the specialty network and other key external stakeholders on a regular basis to ensure accurate and consistent reporting. This critical role will be part of the team that is developing outside the box solutions that provide actionable data insights to our clients.   This is an ideal role for someone looking for an opportunity to make a big impact, and have an opportunity to develop innovative tools, while having the flexibility and autonomy of a remote work environment.                    

The fundamentals for the job…

• Design and develop data solutions - utilize data mining, data modeling, natural language processing, and machine learning to extract insights from large data sources.
• Evaluate data scenarios through a product-oriented lens and deliver predictive models that inform business solutions as part of the drug value strategy portfolio.
• Utilize data-oriented programming languages and visualization software to explore, analyze, and interpret large volumes of data in various forms and solve complex business problems.
• Lead the development of analytic tools that will provide data reporting for our clients.
• Develop and manage new and innovative specialty programs based on collaboration with the specialty network of pharmacies and track progress (partnerships (i.e. ROI, launch of initiatives, outreach, metric tracking, etc.)
• Develop monthly and quarterly specialty spend reports to include initiatives, trends in the market, pipeline drugs, and other impactful events
• Optimize and manage specialty claims auditing process (in conjunction with analytics team)
• Drive generation of client-facing tools that help with feasibility, context, and budget and drug forecast models
• Serve as a SME to the analytics team to develop complex reporting.
• Other tasks and projects as needed

What we expect of you

The bold requirements… 

• Bachelor’s degree in business or related area of study, or equivalent combination of education and/or related work experience (In lieu of a degree, equivalent relevant experience may be considered.)
• 8+ years of experience with working with healthcare data analytics (e.g. medical and pharmacy claims data)
• 2+ years of experience with medical or pharmacy data in a health plan or pharmacy benefit manager (PBM).
• Excellent written, interpersonal communication, and presentation skills, including ability to present complex technical concepts in a clear, concise manner to audiences with varying levels of technical understanding
• Experience in Python, R, SQL, advanced statistical methods, and advanced proficiency to utilize data-oriented programming languages, statistical modeling, and visualization software (such as Tableau, PowerBI, etc.)
• Experience with cloud-based data analysis (such as Snowflake)
• Strong problem-solving skills in healthcare cost and utilization analysis
• Experience in project management, KPI’s, and data visualization.
• Experience managing key strategic initiatives in healthcare/PBM industry.
• We are proud to offer a flexible hybrid work model which will require certain on-site workdays (Puerto Rico Location Only)
• This position requires availability to work in a specified time zone or working schedule, accommodating the business needs of our clients and team members.
• This position may require availability for on-call hours, including evenings, weekends, and holidays, to promptly address emergent issues or provide necessary support as dictated by operational demands (if applicable).

Nice to have…

• Multiple successfully completed data science projects involving ML or algorithm application. For example, prediction of clinical outcomes (disease state complications using support vector machines).
• Expertise in healthcare coding (CPT, ICD, HCPCS).
• Understanding of the healthcare market dynamics.
• Significant experience in formulary and regulatory requirements for Medicaid and/or Medicare
• Experience in designing and developing AI applications and systems.

Physical requirements…

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves.  We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify.  “Abarca Health LLC does not sponsor employment visas at this time”

The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.

#LI-MH1 #LI-REMOTE

What you’ll do

In a few words… 

Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning… 

Our Sales and Business Development gurus are the revenue generating team within Abarca. They're entrusted with foraging and developing relationships with prospects andconsultants andhandle everything related to marketing our value proposition, demoing our capabilities, proposal management, and contracting. 

As Associate Vice President of Consultant Sales, you’ll be responsible fordeveloping pipeline directly through payors and bymanaging existing and creating new consulting firm relationships. The primary areas of focus will be to coordinate relationships with key contacts in thehealth plan andconsulting community, drive strong relationships,understanddemoand shareour solutions and capabilities, and collaborate with key groups within Abarca as needed.  As AVP of Consultant Sales, you will be measured on pipeline creation and business contracted. You’ll also exemplify the aspirational performance-oriented culture of Abarca, exudinghumbleconfidence and always seeking to improve the already great relationships we’ve created over the years, ultimately generating revenue for the company. 

The fundamentals for the job…  

• Developfull sales cycle from prospecting, RPF management, negotiating company specific contracts and pricing (including detailing language for contract execution).
• Collaborate with analytics, product, and marketing teams to create and update educational material for the consulting community.
• Create and deliver prospect andconsultant value proposition messaging highlighting Abarca’s differentiators in the PBM industry.
• Support the RFP strategyfrom the beginning to the end.
• Develop target market strategies and create a sales toolkit required to sell services in conjunction with Abarca’s SVP of Sales, through addressable market analysis and market knowledge by creating go-to market strategies.
• Ensure all targeted prospect contacts and engagement opportunities are recorded in Salesforce.
• Execute strategy for specific pipeline development that supports the assigned sales goals.
• Maintain and improve existing national and regional consultant relationships by strategically allocating resources to maximize growth and retention.
• Create and manage consultant scorecards that provide insight into win/loss and retention results on a quarterly basis.
• Collaborate with Marketing and Technology to create the Book of Business reviews on an annual basis.
• Attend and speak at events including conferences, consultantsummits, and other health plan events.
• Be exceptionally open and proactive in addressing problems as they arise, bring solutions to the leadership team, and present clear recommendations.
• Possess the self-confidence to operate in a direct environment, speaking up and providing opinions grounded in fact while remaining humble and taking direction well. 

What you’re made of 

The bold requirements…  

• Bachelor’sDegree orMaster’s Degree in Business Administration, Healthcare, or a related area (In lieu of a degree, equivalent, relevant work experience may be considered.)
• 10+ years of experience in a consulting, sales, or account management role working with benefit consultants in the healthcare or government market segment.
• Experience successfully forging productive relationships within the healthcare community.
• Experience developing and maintaining trusted relationships with key partnerships that take a long-term view of business opportunities.
• Experience proactively creating relationships and opportunities across both internal and external boundaries to develop innovative solutions to meet our prospect and consultantneeds.
• Experience utilizing Salesforce and contribute to approach for developing, updating, and maintaining relationships with the key contacts at consulting firms.
• Experience successfully interacting, presenting to, and influencing senior leadership.
• Excellent oral and written communication skills.
• Must be available to travel (25nights per year) to industry events, client meetings, headquarters and other sites as needed.
• We are proud to offer a flexible hybrid work model which will require certain on-siteworkdaysin Puerto Rico. 
• This position requires availability to work in a specified time zone or working schedule,accommodation forthe business needs of our clients and team members. 
• This position may require availability for on-call hours, including evenings,weekends, and holidays, to promptly address emergent issues or providenecessarysupport as dictated by operational demands (if applicable). 

Nice to haves…  

• MBA or PharmD is a plus. 

Physical requirements… 

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing. 

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves.  We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. 

Abarca Health LLC is an equal employment opportunity employer andparticipatesin E-Verify.  “Abarca Health LLC does not sponsor employment visasat this time” 

The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails. 

 #LI-NO1 #LI-REMOTE