Analyst, Pharmacy Operations

SCOPE OF ROLE

The Pharmacy Operations Analyst will focus on establishing and refining operational processes related to CMS and State requirements. This position will develop an oversight structure of PBM, departmental and key stakeholder activities. stakeholders. This oversight structure will include the establishment of KPI’s and program dashboards to measure performance.

ROLE RESPONSIBILITIES

Core responsibilities will involve project management, operational management, and materials management. The job description below is intended to point out other responsibilities within the role, but it is not limited to these items.

• Manage, and oversee Medicare Part D requirements and corresponding operational processes.   Including, but not limited to:  Prescription Drug Events (PDE’s), Financial Information Reports (FIR’s), Coordination of Benefits (COB) and NX Transactions
• Develop and manage project plans for PBM, internal stakeholder, or external vendor initiatives to ensure an accurate, timely and highly coordinated implementation
• Define and document corporate oversight processes, policies, and procedures for all delegated pharmacy functions including those intended to identify risk and internal controls.
• Intake, manage, and resolve inquiries, issues, audits, or requests for information that may come from members, stakeholders, states, CMS and/or any other channel.
• Establish PBM KPIs and Program dashboards to manage and measure outcomes related to performance guarantees.Help prepare and disseminate dashboards and/or reporting associated with Pharmacy compliance, PBM oversight, financial and plan performance, claims payment and accuracy, utilization management, customer service, rebates, and operational performance. 
• Draft and maintain administrative pharmacy policies related to core job responsibilities.
• As required, present PBM performance dashboards to senior leaders of Bright Health
• Collaboratively work with both clinical and non-clinical areas within Bright.

SUPERVISORY RESPONSIBILITIES

• This position does not have supervisory responsibilities.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• Bachelor’s in Science Degree required
• Seven (7) years of professional experience in Pharmacy at a health plan or PBM.
• Five (5) years of project management/relationship management experience required, preferably in the pharmacy or healthcare industry preferred.
• Five (5) years of experience in triaging and resolving inquiries associated to claims and benefits.
• Five (5) years of experience working Medicare Part D

PROFESSIONAL COMPETENCIES

• Able to formalize and lead process oversight, data review, and resolutions needed when applicable.
• 100% team player and ability to collaborate effectively with others to achieve common goals.
• Able to multi-task and set priorities with strong organization and problem-solving skills supporting and enabling sound decision-making.
• Advanced Excel and PowerPoint skills to create Executive Level schedules and presentations.
• Strong analytic and critical thinking skills to resolve complex situational issues requiring design of processes which are lean, repeatable and comprehensive.
• Self-starter that can develop and execute on a plan to address ambiguous situations or ones with limited direction.
• Exceptional attention to detail.
• Excellent customer service and communication skills.
• Excellent written and verbal communication skills; ability to provide clear and concise information to senior leaders.
• Comfortable following timeline driven workplans and managing multiple projects; thrive in collaborative environments.

LICENSURES AND CERTIFICATIONS

• No licensures and/or certifications are required for this role.

WORK ENVIRONMENT

• Remote