Resp & Qualifications
PURPOSE:
Responsible for all key aspects of Medicare Pharmacy operations including formulary and benefits administration and testing, CMS reporting and compliance, Pharmacy Benefits Management oversight and validation, new plan implementations, Prescription Drug Event and Coverage Determination, Appeals and Grievances analysis, policies, and procedures. Work with business leaders to determine business needs and transform them into program requirements. Supervises and monitors the day-to-day activities of staff. Organizes work and provides direct supervision to subordinates.
ESSENTIAL FUNCTIONS:
- Supervises the teams daily activities. Assigns work and delegates responsibility and authority to team members. Provides regular performance feedback to each team member. Ensures that team members are kept abreast of all relevant standards and methods. Maintains resource models to ensure that resources are utilized appropriately to meet key goals and objectives. Assists with the management of the teams budget.
- Ensures successful completion of day-to-day changes, corporate initiatives, and other projects by supervising team to ensure effective, compliant pharmacy operations activities spanning request analysis, requirements documentation, development, and maintenance of operating procedures, operations support, and implementation impact assessment.
- Ensures successful completion of other pharmacy tasks, such as daily maintenance of all operational files, timely investigation and support of member issues, updating user documentation, and production of ad hoc reports. Ensures development and oversees use of team controls, processes, support and monitoring, which includes issue analysis, tracking, and resolution.
- Participates in planning sessions to ensure that the teams operations and long-range goals are coordinated with other department staff, interdependent business units, and members. Assist manager with planning the the development of project management plans for day-to-day changes, corporate initiatives, and other projects. Oversees corporate processes for systems change management, spanning request submission, review, validation, prioritization, scheduling, and status reporting.
SUPERVISORY RESPONSIBILITY:
This position manages people.
QUALIFICATIONS:
Education Level: Bachelor's Degree in Business Administration or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
Experience: 3 years Business or Systems Analysis experience. Demonstrated leadership skills.
Preferred Qualifications:
- Certified Pharmacy Technician (CPhT) Certification
Knowledge, Skills and Abilities (KSAs)
- Demonstrated in-depth experience with pharmacy benefits, technologies, systems, and business processes supported by the department (e.g., claims processing, enrollment and billing, financial, etc.).
- Experience in industry best practices for project management (including resource estimating, tracking, and metrics), business/systems analysis, and software testing. Demonstrated competence with full software development project life cycle.
- Must be able to evaluate demands on a timely basis and distribute resources effectively, establish and manage multiple priorities, and respond appropriately to unplanned events/projects.
- Excellent written and verbal communication, interpersonal, analytical, and problem-solving skills.
Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Salary Range: $85,680 - $176,715
Salary Range Disclaimer
The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).
Department
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
PHYSICAL DEMANDS:
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship
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