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Devoted Health seeks a Drug Trend Management Pipeline Development Senior Manager to lead the identification and evaluation of drug cost, safety, and integrity opportunities across Medicare Part B and Part D. This is a high-impact analytical role focused on pattern detection and opportunity assessment within a managed care pharmacy context.
You will maintain and work through a standing book of drug-related opportunities, each representing patterns across member cohorts. Your core responsibilities include: (1) validating whether identified patterns are real signals or data artifacts; (2) sizing financial and clinical opportunity; (3) determining if similar opportunities are already in flight; (4) building compelling clinical and financial cases for viable opportunities; (5) identifying the appropriate organizational lever (utilization management, policy, claims edits, partner coordination, or special investigations) and making the case to the owner; (6) closing feedback loops to improve upstream detection capabilities; and (7) growing into pipeline production and prioritization as you demonstrate judgment.
You will report to the Director, Clinical Pharmacy and serve as the analytical backbone connecting organizational capabilities—UM, payment integrity, special investigations, actuarial, and data science functions—into coordinated responses.
Required: 5–8 years in managed care pharmacy, utilization management, drug trend, or program integrity with meaningful Part B and Part D exposure. Deep pharmacy domain expertise (NCPDP, GPI, DAW, NDC, HCPCS, buy-and-bill). Population-level analytical thinking. Medicare regulatory fluency (protected classes, formulary rules, CMS timing, transition fills, coverage boundaries, appeals). Hands-on claims data analysis. Strong written and verbal communication. Breadth across actuarial, data science, and investigation domains. Evidence of continuous learning and process improvement.
Desired: Experience with detection, suspicion, or FWA models. Familiarity with payment integrity, SIU, or actuarial workflows. Data rigor (open/closed periods, denominator shifts).
