Manager Medicare Pharmacy Operations
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Job Summary
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
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. (Example: Contract negotiating/management, coordinating
and assuring vendor compliance etc.).
Minimum two (2) years' leadership experience (role, team and/or project management).
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 identifying appropriate solution(s).
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
• Microsoft 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 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.
Certifications
Security Requirements
This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.
Segregation of Duties
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. This position must adhere to the segregation of duties guidelines in the Administrative Manual.
Employment Type
Regular
ADA Requirements
1.1 General Office Worker, Sedentary, Campus Travel – someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment.
Job Summary
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
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. (Example: Contract negotiating/management, coordinating
and assuring vendor compliance etc.).
Minimum two (2) years' leadership experience (role, team and/or project management).
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 identifying appropriate solution(s).
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
• Microsoft 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 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.
Certifications
Security Requirements
This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.
Segregation of Duties
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. This position must adhere to the segregation of duties guidelines in the Administrative Manual.
Employment Type
Regular
ADA Requirements
1.1 General Office Worker, Sedentary, Campus Travel – someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment.