Lead revenue growth and margin expansion strategy across LATAM. Engage with diverse stakeholders to develop effective RGM solutions.
About the role
- Pricing Manager at Abarca Health managing end-to-end MAC program for pharmacy benefits. Involves cross-functional collaboration and strategic implementation of pricing strategies.
Responsibilities
- Own MAC strategies, and work to transform MAC strategies in MAC pricing lists for retail, mail, specialty, and LTC
- Implement robust MAC QC process including evaluation of outliers, review of impactful changes, peer review process
- Analyze client and pharmacy guarantee performance and consult with a cross-functional team to craft strategies that generate savings for Abarca clients
- Set/tune methodology using NADAC, WAC, AMP, acquisition-cost proxies, floors/minimums, and dispensing-fee logic.
- Operate MAC under third-party leased-network rules (update cadence, file formats, distribution, communications).
- Develop performance-guarantee dashboards, and monitor and report out performance to the Pricing Oversight Committee
- Collaborate cross-functionally to stay highly aware of pharmacy network contracting and generic Maximum Allowable Cost (MAC) pricing strategy to ensure it aligns with the underwriting strategy.
- Work in Snowflake and within the Darwin platform to identify claims with aberrant pricing and validate accurate application of MAC
- Own investigations, reporting, and responses related to any audit questions related to MAC pricing
- Work with the underwriting team to help determine MAC strategies for prospective and new clients
- Monitor unit cost trend, spread, GER/BER, and outliers; produce monthly MAC scorecards (savings, appeal TAT/overturns, cycle time, top movers).
- Interpret state MAC statutes and CMS/Medicaid requirements; maintain SOPs, controls, and audit evidence; lead remediation when needed.
- Define data requirements and QC for Snowflake pipelines (NADAC refresh, vendor feeds, wholesaler invoice ingestion).
Requirements
- 8+ years in PBM or payer pharmacy pricing/network ops.
- 3+ years hands-on MAC strategic and operational ownership.
- Fluency in generic pricing levers and PBM business model and terminology.
- Highly analytical mindset.
- Working knowledge of NADAC, WAC, AMP, ASP and state MAC laws; Medicare/Medicaid familiarity.
- Data skills: intermediate/advanced SQL (Snowflake preferred) and Tableau/Power BI; strong Excel.
- Clear stakeholder communication (pharmacies, clients, regulators) and rigorous documentation.
- Flexibility for occasional off-hours support during pricing cycles or audits.
- Excellent oral and written communication skills.
- Nice-to-haves: Proficiency in Python
Benefits
- Flexible hybrid work model which will require certain on-site workdays (Puerto Rico Location Only)
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