Sr Manager, Managed Care Rebate Integrity & Controls

Job Summary The Senior Manager, Managed Care Rebate Integrity & Controls provides strategic oversight of pharmacy and medical rebate validation to protect revenue, ensure contractual compliance, and strengthen Gross-to-Net integrity. This role leads to enterprise governance over data validation, dispute strategy, accrual accuracy, and vendor performance (including IQVIA), partnering cross-functionally with Contracting, Government Pricing, Finance/FP&A, and GTN teams. The position drives analytics, automation, and systemic corrective actions to reduce financial leakage, improve recovery outcomes, and ensure audit-ready compliance across payer rebate programs. Salary Range: $140,000 - $165,000 per year Position is eligible to participate in a bonus plan with a target of 14% of the base salary. Final pay determinations will depend on various factors, including, but not limited to experience level, education, knowledge, skills, and abilities. Our benefits and programs are comprehensive and thoughtfully crafted to ensure our colleagues live healthy lives and have support when it matters most. Responsibilities Set enterprise validation strategy and own end-to-end rebate revenue integrity across pharmacy and medical benefit claims, establishing the validation control tower for eligibility, pricing, formulary/coverage compliance, utilization logic, unit conversions - ensuring the organization pays only on validated, contract-compliant utilization. Establish and oversee data integrity governance for rebate submissions, including lookback methodologies, product and plan eligibility controls duplicate for integrity, duplicate detection (including 340B/Medicaid overlap prevention), unit of measure normalization, quantity/day supply analytics, dispenser eligibility and exclusion enforcement. Lead contract operationalization and policy translation in partnership with Contracting/Legal: interpret and operationalize eligibility rules, rate structures, utilization definitions, and data submission requirements; recommend contract language enhancements to reduce ambiguity, increase leverage, and prevent leakage before it occurs. Maintain strong understanding of PBM/MBM formulary structures, coverage criteria, benefit design changes, and how they impact rebate qualification. Serve as subject matter expert on PBM/MBM formulary structures and benefits design changes for financial, contractual and GTN impact. Sponsor, Design & Lead payer rebate audit program (third-party). Set risk-based cadence and audit plan; manage auditor relationship; define scope, sampling, and data requests; oversee audits validating payer claims/submissions; drive recoveries, corrective actions, and executive reporting to protect rebate revenue. Drive alignment across Government Pricing, Chargebacks, and Gross-to-Net (GTN) functions, ensuring consistent treatment of rebates, accrual methodologies, reporting transparency, and downstream financial integrity. Lead development of analytics and automation strategy, delivering executive dashboards and KPIs including validation effectiveness, denial root causes, dispute win rates, cycle time performance, recovery value, exposure tracking, and vendor SLA adherence. Provide strategic accrual oversight and forecasting partnership with Finance/FP&A, incorporating validity trends, seasonality, exposure risk, and emerging utilization shifts into forecasting and true-up processes. Ensure audit-ready documentation and governance, maintaining defensible dispute rationales, financial traceability, and recovery tracking consistent with internal controls and external audit expectations. Identify systemic drivers of recurring disputes and financial leakage, leading cross-functional corrective actions, control redesign, and master data enhancements to prevent recurrence. Provide executive oversight of outsourced/vendor relationships (e.g., IQVIA), ensuring performance against SLAs, quality standards, control effectiveness, error remediation, and continuous improvement initiatives. Ensure enterprise compliance with contractual obligations, audit standards, and Gross-to-Net (GTN) policy requirements, mitigating financial, regulatory, and reputational risk. Lead audit engagement and regulatory support efforts related to PBM/MBM rebate programs, serving as primary point of accountability for data integrity, documentation, and compliance response. All employees are responsible for ensuring compliance to company documents, programs and activities related to the Health, Safety, Environment, Energy, and Quality Management Systems, as per your roles and responsibilities. Requirements Bachelors 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 24 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). Excellent communication skills for crossfunctional and payer/vendor interactions. The ability to work in a complex and changing environment with minimal supervision, make independent decisions and work within a team environment. Ability to initiate complex analysis, manage details, and provide strategic perspective. Additional Information We offer an excellent salary and benefits package including medical, dental and vision coverage, as well as life insurance, disability, 401K with company contribution, and wellness program. Please note that joining our team does not create a guaranteed or permanent employment arrangement. All employment is atwill, meaning both the employee and Fresenius Kabi have the right to end the employment relationship at any time, in accordance with applicable federal and state laws. Fresenius Kabi is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, citizenship, immigration status, disabilities, or protected veteran status. Fresenius Kabi (www.CaringForLife.us) is a global health care company that specializes in injectable medicines, biosimilars, and technologies for infusion, transfusion, and clinical nutrition. Our expansive portfolio of products and global network of science and manufacturing centers provide essential support for the care of critical and chronically ill patients. With more than 41,000 employees worldwide, our dedicated team is united by our shared purpose: to put lifesaving medicines and technologies in the hands of people who care for patients and to find answers to the challenges they face. We call this purpose caring for life. Our U.S. headquarters is in Lake Zurich, Illinois and the companys global headquarters is in Bad Homburg, Germany. Follow us on LinkedIn to learn more: http://bit.ly/3KdaGJr Fresenius Kabi is aware that scammers may attempt to impersonate our recruiters. While we have limited ability to stop these illegitimate efforts, there are some things you can do to protect yourself and not waste time communicating with an imposter. Check the email address messages from our recruiters will always come from a company account with the Fresenius-kabi.com domain. We have seen imposters send emails using Fresenius-kaabi.com which of course includes an extra a in Kabi. Check our website to see if the position you were contacted about is actually posted. Be wary if someone asks you for personal information. We do not need your drivers license, social security number, or bank account information before we have made you a conditional offer of employment. Refuse to pay any upfront fees. Fresenius Kabi never charges you a fee to apply for a job at Fresenius Kabi. We will not send you an invoice for equipment (such as a laptop) that we promise to order and reimburse you for once you start working. If you have any questions at any stage of the process, contact us at Careers@fresenius-kabi.com. Do not use any contact information in an unsolicited email. We look forward to talking to you about joining our team.