Manager-SHP Pharmacy Operations (Remote in Oregon)
JOB SUMMARY/PURPOSE
Manages non-clinical pharmacy benefits administration and formulary management. Areas of oversight include formulary integrity, pharmacy benefit customer service, member engagement and grievances, and vendor oversight on delegated functions in these areas. Develops and implements program standards, benchmarking, and ensures adequate quality assurance and ongoing review of processes and standards. Works closely with pharmacy management and other staff and managers across the organization in support of both departmental and organizational goals.
DEPARTMENT DESCRIPTION
Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services self-funded employee health benefit plan. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services mission of Building Healthier Communities Together.
EXPERIENCE/EDUCATION/QUALIFICATIONS
Bachelors degree or equivalent experience in a related field required.
Certified Oregon Pharmacy Technician License required.
Four (4) years experience in a managed care setting required.
Two (2) years experience working with regulatory bodies such as Centers for Medicare and Medicaid (CMS) and the Oregon Health Authority (OHA) required.
Experience in program or project monitoring and coordination required.
KNOWLEDGE/SKILLS/ABILITIES
Leadership - Inspires, motivates, and guides others toward accomplishing goals. Achieves desired results through effective people management.
Conflict resolution - Influences others to build consensus and gain cooperation. Proactively resolves conflicts in a positive and constructive manner.
Critical thinking Identifies complex problems. Involves key parties, gathers pertinent data and considers various options in decision making process. Develops, evaluates and implements effective solutions.
Communication and team building Leads effectively with excellent verbal and written communication. Delegates and initiates/manages cross-functional teams and multi-disciplinary projects.
Knowledge of the principles of managed care and health plan operations. Knowledge of the Oregon Health Plan, Medicare Part D benefits and other regulatory requirements as it relates to health plan operations.
Proficient in computer and database utilization including MS Windows, Word, Excel, PowerPoint and Outlook.
PHYSICAL DEMANDS
Rarely
(1 - 10% of the time)
Occasionally
(11 - 33% of the time)
Frequently
(34 - 66% of the time)
Continually
(67 100% of the time)
LIFT (Floor to Waist: 0"-36") 0-20 Lbs
LIFT (Knee to chest: 24"-54") 0 - 20 Lbs
LIFT (Waist to Eye: up to 54") 0 - 20 Lbs
CARRY 1-handed, 0 - 20 pounds
CARRY 2-handed, 0 - 20 pounds
KNEEL (on knees)
BEND FORWARD at waist
CLIMB - STAIRS
STAND
WALK - LEVEL SURFACE
ROTATE TRUNK Standing
REACH - Upward
PUSH (0-20 pounds force)
PULL (0-20 pounds force)
SIT
ROTATE TRUNK Sitting
REACH - Forward
MANUAL DEXTERITY Hands/wrists
FINGER DEXTERITY
PINCH Fingers
GRASP Hand/Fist
None specified
PI255912322
Apply Now
Manages non-clinical pharmacy benefits administration and formulary management. Areas of oversight include formulary integrity, pharmacy benefit customer service, member engagement and grievances, and vendor oversight on delegated functions in these areas. Develops and implements program standards, benchmarking, and ensures adequate quality assurance and ongoing review of processes and standards. Works closely with pharmacy management and other staff and managers across the organization in support of both departmental and organizational goals.
DEPARTMENT DESCRIPTION
Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services self-funded employee health benefit plan. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services mission of Building Healthier Communities Together.
EXPERIENCE/EDUCATION/QUALIFICATIONS
Bachelors degree or equivalent experience in a related field required.
Certified Oregon Pharmacy Technician License required.
Four (4) years experience in a managed care setting required.
Two (2) years experience working with regulatory bodies such as Centers for Medicare and Medicaid (CMS) and the Oregon Health Authority (OHA) required.
Experience in program or project monitoring and coordination required.
KNOWLEDGE/SKILLS/ABILITIES
Leadership - Inspires, motivates, and guides others toward accomplishing goals. Achieves desired results through effective people management.
Conflict resolution - Influences others to build consensus and gain cooperation. Proactively resolves conflicts in a positive and constructive manner.
Critical thinking Identifies complex problems. Involves key parties, gathers pertinent data and considers various options in decision making process. Develops, evaluates and implements effective solutions.
Communication and team building Leads effectively with excellent verbal and written communication. Delegates and initiates/manages cross-functional teams and multi-disciplinary projects.
Knowledge of the principles of managed care and health plan operations. Knowledge of the Oregon Health Plan, Medicare Part D benefits and other regulatory requirements as it relates to health plan operations.
Proficient in computer and database utilization including MS Windows, Word, Excel, PowerPoint and Outlook.
PHYSICAL DEMANDS
Rarely
(1 - 10% of the time)
Occasionally
(11 - 33% of the time)
Frequently
(34 - 66% of the time)
Continually
(67 100% of the time)
LIFT (Floor to Waist: 0"-36") 0-20 Lbs
LIFT (Knee to chest: 24"-54") 0 - 20 Lbs
LIFT (Waist to Eye: up to 54") 0 - 20 Lbs
CARRY 1-handed, 0 - 20 pounds
CARRY 2-handed, 0 - 20 pounds
KNEEL (on knees)
BEND FORWARD at waist
CLIMB - STAIRS
STAND
WALK - LEVEL SURFACE
ROTATE TRUNK Standing
REACH - Upward
PUSH (0-20 pounds force)
PULL (0-20 pounds force)
SIT
ROTATE TRUNK Sitting
REACH - Forward
MANUAL DEXTERITY Hands/wrists
FINGER DEXTERITY
PINCH Fingers
GRASP Hand/Fist
None specified
PI255912322
Apply Now