Manager Medicare Pharmacy Operations

Arkansas Blue Cross Blue Shield

10d

About The Position

The Manager Medicare Pharmacy Operations serves as a liaison with contracted vendors that provide administrative and clinical services for the pharmacy program. This role has primary responsibility for the development and implementation of new benefit plans, products, and strategies designed 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 and prevention, 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 primary focus on ensuring execution against requirements.

Requirements

• Bachelor's degree in a related field. In lieu of degree, five (5) years' experience in a pharmacy environment with be considered in addition to the experience requirements listed below.
• Minimum seven (7) years' experience within a pharmacy environment OR applicable Masters in related field with minimum five (5) years' experience.
• Minimum five (5) years' experience dealing with external vendors and end users. (Example: Contract negotiating/management, coordinating and assuring vendor compliance etc.).
• Minimum two (2) years' leadership experience (role, team and/or project management).
• Ability to travel
• Ability to work collaboratively and independently in a matrix work environment.
• Ability to understand individual and operational problems and identifying appropriate solution(s).
• Ability to perform under pressure and/or opposition.
• Coaching Others
• Conflict Resolution
• Continued Learning
• Critical Thinking
• Cross-Functional Communications
• Decision Making
• Employee Engagement Strategies
• Interpersonal Communication
• Interpersonal Relationships
• Management Techniques
• Microsoft Office
• Oral Communications
• Service Oriented
• Time Management
• Written Communication

Nice To Haves

• Pharmacy Doctorate (PharmD) from an accredited college of pharmacy preferred.
• Experience in managed care, pharmacy management, utilization management, or other related functions preferred.
• Knowledge of the Medicare Part D and Medicare Advantage benefits preferred.

Responsibilities

• Collaborates with team to prepare reporting and documentation.
• Consults, recommends, and/or develops quality and cost initiatives to enhance the Centers for Medicare & Medicaid Services (CMS) measures of our 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.

Benefits

• Tuition reimbursement.
• Club Blue, a free, onsite gym to encourage exercise.
• Green Leaf Grill and Green Leaf Grill Express, onsite restaurants in Little Rock that promote healthy eating.
• Incentives for wellness education and exercise

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 501-1,000 employees