Manager- Business Assurance

About the Department 

The Finance and Operations dept. brings insights and intelligence to inform decision making & drives digitalization and business solutions to attain NNI goals. Finance and Operations works closely across the organization to guide enterprise-wide resource allocations, investment choices, drive core operations and develop insights to drive growth and operational excellence across the value chain while innovating for future capabilities. Our focus on innovation ensures we're constantly building future capabilities. We're responsible for regulating accounting, upholding workplace safety, managing our supply chain and sampling, supporting technological and data innovation, insights and analytics, delivering patient support solutions, maintaining our facilities and assuring the integrity and completeness of all business transactions. At Novo Nordisk, you will have the opportunity to build a life-changing career in a global business environment. We encourage our employees to make the most of their talent, and we reward hard work and dedication with opportunities for continuous learning and personal development. Are you ready to maximize your potential with us?

The Position

This position leads the business assurance function for Managed Care contracts. The role is responsible for managing an external team whose primary role is to ensure the validation of formulary eligibility for invoicing of all Commercial and Part D rebates. This includes the implementation and development of processes and procedures. Responsible for the development of best in class processes for formulary validation and research. Identify and track formulary compliance for Commercial Contracts team. Responsible to all aspects of commercial customer audits, from engagement of audit vendor, alignment of state holders, through audit resolution.

 

Relationships

Reports to the head of Rebate Operations & Insights and works closely with Rebate Operations and Insights, Contract Management and Compliance and Strategic Pricing teams, field and home office management. External relationships include oversight of Novo Nordisk Global Service Center formulary management team, managed care customers, field sales personnel and system vendors.

 

Essential Functions

• Accountable for formulary compliance research including review of preferred drug lists and plan policy documents
• Monitor formulary compliance to ensure contract profitability as well as contract compliance by the customer
• Provides analysis support around commercial rebate exclusions, formulary compliance, and utilization management controls and reports out to internal leadership and account teams
• Provide recommendations to Strategic Pricing team on formulary research findings to improve contract strategies
• Ensuring compliance between contractual exclusion language and contract set up in the third-party system
• Monitoring 340B compliance as well as calculation of third-party fees related to identification of 340B duplicate discounts
• Works with external vendors on enhancements to validation tool and/or exclusion processes
• Works with Account Executives and customers to verify formulary discrepancies as well as resolve open disputes
• Demonstrates knowledge of internal business operations and applies this knowledge to analyses, processes and deliverables
• Consistently follows company policies and procedures to ensure compliance with all guidelines, Sarbanes Oxley compliance, regulations, and policies
• Identifies opportunities and makes recommendations for optimal performance, processes, and compliance improvement
• Trains and mentors new team members in the areas of systems, processes, analytic models and presentations
• Leads with excellent communication and interpersonal skills and demonstrates effectiveness at working with stakeholders

 

Physical Requirements

0-10% overnight travel required.

 

Qualifications

• Bachelor's degree preferred; relevant experience may be substituted for degree when appropriate
• Requires a minimum of 6 years of progressively responsible, relevant experience; at least 3 years in pharmacy or medical claims, formulary analysis, contract analysis, rebate administration, or utilization management controls required
• In-depth knowledge of US healthcare systems & strong understanding of payer formulary concepts and processes required
• Ability to perform analysis; identify trends and insights; and translate into actionable insights required
• Ability to communicate at all levels of the organization
• Ability to develop and maintain strong internal and external relationships
• Demonstrated critical thinking and analytical skills required.
• Attention to detail and readiness to delv