[Remote] Manager Medicare Pharmacy Operations
Note: The job is a remote job and is open to candidates in USA. Arkansas Blue Cross and Blue Shield is seeking a Manager Medicare Pharmacy Operations who will serve as a liaison with contracted vendors providing administrative and clinical services for the pharmacy program. This role involves developing and implementing new benefit plans and strategies to enhance the company's competitive position while ensuring compliance with Medicare requirements.
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
Skills
- Bachelor's degree in a medical field required
- 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)
- 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
- Pharmacy Doctorate (PharmD) or Nurse Practitioner (NP) from an accredited college 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
Company Overview