Provide strategic oversight of pharmacy and medical rebate validation to protect revenue, ensure contractual compliance, and strengthen Gross-to-Net integrity.
Lead enterprise governance over data validation, dispute strategy, accrual accuracy, and vendor performance.
Drive analytics, automation, and systemic corrective actions to reduce financial leakage, improve recovery outcomes, and ensure audit-ready compliance across payer rebate programs.
Set enterprise validation strategy and own end-to-end rebate revenue integrity across pharmacy and medical benefit claims.
Establish and oversee data integrity governance for rebate submissions.
Lead contract operationalization and policy translation in partnership with Contracting/Legal.
Maintain strong understanding of PBM/MBM formulary structures, coverage criteria, benefit design changes.
Serve as subject matter expert on PBM/MBM formulary structures and benefits design changes.
Sponsor, Design & Lead payer rebate audit program.

Bachelor’s degree in finance, Business, Analytics, Pharmacy Administration, Accounting, or related field.
8+ years in pharma/biotech rebates, managed care operations, GTN, or contract/revenue integrity, with 2–4 years people leadership.
Strong understanding of PBM & MBM rebate programs, NCPDP data formats, formulary structures, and rebate contract terms.
Hands-on experience with rebate validation and disputes for PBM and medical benefit (e.g., J-code claims, buy-and-bill).
Experience working with or managing external vendors (e.g., IQVIA, Model N).
Strong analytical abilities and experience with large datasets (Excel, Power BI, Snowflake preferred).

Senior Manager, Managed Care Rebate Integrity – Controls

Key skills