Pharmacy Performance Manager

Wellmark•Sioux Falls, IA

23h•Hybrid

About The Position

Join our growing Pharmacy team and use your strengths at Wellmark! As a Pharmacy Performance Manager, you will manage the effectiveness of business process, performance, and key partnerships pertaining to Wellmark’s pharmacy line of business, including strong relationships primarily pertaining to Wellmark’s Pharmacy Benefit Manager (PBM) partner. You will monitor and ensure delivery of service level agreements (SLAs), cost-saving initiatives and contract compliance. You will do this by analyzing data points and trends through multiple sources and identifying criteria to build out dashboards and processes to monitor performance. You will work closely with internal stakeholders (clinical, procurement, member experience, etc.) as well as external stakeholders to help guarantee the pharmacy benefits program aligns with Wellmark’s overall corporate strategy. You will be uniquely situated as the “go-to” for pharmacy performance inquiries and will tap into resources and market trends to guide recommendations and decisions.

Requirements

Bachelor’s degree in healthcare administration, business, or related field, or applicable experience.
Minimum of 5 years of experience in health insurance or related field.
2-3 years of experience with vendor relationships and performance monitoring with understanding of contracts.
Strong business intuition and natural curiosity with strong abilities to communicate actionable insights to support business decisions.
Excellent analytical skills with the ability to interpret complex data and to identify issues or inconsistencies, research root cause and identify alternative solutions.
Strong financial understanding pertaining to invoices/billings, etc.
Strong organizational and process improvement skills to facilitate and manage the implementation of process improvements.
Effective consultation skills with the ability to provide recommendations, influence others to action, and solicit collaboration.
Viewed as a subject matter expert and go-to resource.
Strong communication and interpersonal skills, with the ability to present data clearly and succinctly to various audiences, including up to senior leadership.
Self-starter with strong organizational skills and the ability to multi-task priorities.
Ability to prioritize initiatives, align appropriate resources, and motivate teams to achieve success.
Flexible and adaptable to change.
Knowledge of healthcare regulations and compliance requirements including Centers for Medicare & Medicaid Services (CMS), HIPAA, ACA, etc.
Proficient in Microsoft Office suite and has the technical aptitude to learn new systems and software quickly (PowerBI, Visio, PBM statistical systems, etc.).

Nice To Haves

Strong knowledge of PBM operations, pharmacy benefits design, etc.
Experience working with PBM statistical systems.
Proficiency in HROR highly preferred.

Responsibilities

Proactively and collaboratively work across the pharmacy team, executive leadership, key stakeholders, and pharmacy vendors to measure and analyze the effectiveness of business processes for the business unit based on deep situational awareness of the business environment.
Ensure business processes are in place to successfully continue running the business (e.g. relevant process mapping, policies and procedures, etc.).
Lead efforts to ensure internal dashboards are created for ongoing monitoring of performance based on agreed upon key performance indicators (KPIs).
Design, document, and implement process changes that improve efficiency, enhances effectiveness and/or increases productivity across both internal and vendor solutions.
Develop alternative solutions and advise on what options could look like, where the risks lie, costs vs benefits, and downstream impacts on other business processes and systems.
Lead regular performance reviews with the PBM to ensure compliance with key performance indicators (KPIs) and service level agreements (SLAs).
This includes strong relationship management with the vendor to understand their created member experience aligns with Wellmark’s desired member experience as well as strong partnership with Wellmark’s internal Member Experience team to understand roadmaps and analytics gathered around pharmacy experience.
Track and analyze PBM performance data.
Gain an understanding of how vendor collects and represents data and validate key metrics to be shared with internal stakeholders.
Identify risks or areas of concern and work closely with vendor to create action plans.
Ensure action plans are addressed or updates are made during quarterly business reviews or based on business requests.
Identify and escalate issues related to any performance gaps, as necessary.
Partner with clinical team and/or other internal stakeholders to maintain tracking of clinical or operational requests to ensure timely completion of requests.
Engage with vendor as needed to obtain clarifying information.
Stay up to date with changes in healthcare regulations and help ensure that PBM activities are compliant.
Other duties as assigned.