• Coordinate the implementation and execution of medical drug strategy and management of the pre-determination process for specialty pharmacy. • Drive biosimilar adoption, utilization pathways, clear/white bagging policies, specialty pharmacy partnerships, and sourcing strategies. • Optimize infusion and specialty drug administration settings for cost savings and improved outcomes. • Lead execution of CMS/state drug requirements across systems and providers, Part B Implementation. • Lead QAI efforts for medical drug spend and utilization support cost containment and driving medical forecasting for consistent execution. • Coordinate and collaborate with Pharmacy, Medical, Network, Finance, and Operations to ensure unified execution. • Assist in the development of integrated service delivery to members and oversee data and processes to maintain industry standards and practices. • Assist the Director in developing processes to manage appropriate utilization and assure appropriate payment for specialty/medical drug services and programs. • Interact with providers and staff to manage benefits aligned with regulations, URAC and NCQA regulations and CareSource policies and vision. • Oversee CQI (Continuous Quality Improvement) activities and document departmental processes for internal and external use. • Review and revise workflows to maximize efficiencies. • Monitor productivity and utilization trends. • Regularly report all specialty pharmacy/medical drug data and program performance. • Ensure compliance with and reporting of all regulatory requirements. • Analyze and formulate recommendations based on data. • Maintain and update all departmental policies and procedures. • Act as liaison with other departments to assist with research and intervention. • Perform any other job related duties as requested.

• Support CMS 1/3 Financial Audits • Coordinate and manage audit activities for health plan clients • Work with CMS auditors, health plans, internal teams, and legal partners to ensure audits are completed smoothly • Resolve audit exceptions—especially those related to rebates, DIR, and pharmacy contract testing • Identify process improvements to prevent future issues

• Provide management for the Portfolio Solutions project management team • Set the direction for operations and change-the-business initiatives • Manage changing business needs, resource capacity constraints, risk exposure, and interdependencies • Provide strategic direction and management in maintaining a complex portfolio • Manage stakeholder relationships with senior-level management across various functions • Collaborate with cross-functional business units around project planning, resourcing, and delivery • Collaborate with IT teams and/or external consultants to ensure successful delivery of projects • Provide leadership in constructing project teams, charters, project plans, contingencies, success metrics, and ROI measurements • Guide project managers and analysts to ensure project quality and standards are followed • Regularly interact with sponsors, stakeholders, and executive leadership to meet or exceed project deliverables • Establish and monitor value metrics to inform decisions that maximize returns across enterprise projects and programs • Drive business value across all program activities • Plan, implement, and continuously improve project management best practices

• Hire, mentor, motivate, and manage a team of application analysts who are experts on Zuora Billing and Revenue • Empower your team members with knowledge, an inclusive environment, and opportunities to grow in their careers • Provide technical leadership for your team and the broader organization • Partner with product teams and peer leaders in FinTech to build product and technology roadmaps • Ensure the team delivers on established roadmaps and Objectives and Key Results (OKRs), and participate in organization leadership reviews to track OKR progress • Ensure the quality, scalability, and reliability of the solutions your team delivers • Leverage AI in development practices and solutions • Contribute to the entire development lifecycle and support Scrum and Agile processes