Manager Medicare Pharmacy Operations
Job Summary
The Manager Medicare Pharmacy Operations serves as a liaison with contracted vendors providing administrative and clinical services for the pharmacy program. This role has primary responsibility for developing and implementing new benefit plans, products, and strategies to contain costs and enhance the company’s competitive position in the marketplace. The incumbent represents Government Programs within the enterprise regarding issues such as implementing new programs, problem resolution, utilization management, policy management, and compliance oversight. This role is responsible for various parts of the Medicare Pharmacy Program as defined by the Centers for Medicare and Medicaid Services (CMS), with a primary focus on ensuring execution against requirements.
Requirements
- Education: Bachelor's degree in a medical field required. Pharmacy Doctorate (PharmD) or Nurse Practitioner (NP) from an accredited college preferred.
- Experience & Knowledge: Minimum seven (7) years' experience within a pharmacy, clinical, and/or related health program administration function OR applicable Masters in related field with minimum five (5) years' experience. Minimum five (5) years' experience dealing with external vendors and end users (e.g., contract negotiating/management, coordinating and assuring vendor compliance, etc.). Minimum two (2) years' leadership experience (role, team, and/or project management).
- Knowledge: Experience in managed care, pharmacy management, utilization management, or other related functions preferred. Knowledge of the Medicare Part D and Medicare Advantage benefits preferred.
Essential Abilities
- Ability to travel.
- Ability to work collaboratively and independently in a matrix work environment.
- Ability to understand individual and operational problems and identify appropriate solutions.
- Ability to perform under pressure and/or opposition.
Skills
- Coaching Others
- Conflict Resolution
- Continuous Learning
- Critical Thinking
- Cross-Functional Communications
- Decision Making
- Employee Engagement Strategies
- Interpersonal Communication
- Interpersonal Relationships
- Management Techniques
- Micrsoft Office
- Oral Communications
- Service Oriented
- Time Management
- Written Communication
Responsibilities
- Collaborates with team to prepare reporting and documentation.
- Consults, recommends, and/or develops quality and cost initiatives to enhance CMS measures of the Part D lines of business.
- Develops, implements, and evaluates quality control opportunities (also known as monitoring) for plan performance improvement in pharmacy practice specific to Medicare Part D which includes data analysis using Microsoft Excel and Access reports.
- Develops policies and procedures for operational and business pharmacy management.
- Develops systematic reviews of prescription claims to meet strategic initiatives.
- Provides clinical guidance, support, and oversight to the Medicare teams.
- Works with vendors and cross-disciplinary teams to coordinate activities and oversees the collection, analysis, reporting, and trending of data relative to Medicare Part D performance, outcomes, and return on investment of intervention activities.
Security Requirements
- This position is identified as level three (3).
- The integrity of information must be maintained as outlined in the company Administrative Manual.
- Segregation of Duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business.