Pharmacy Benefit Operations Manager

Job Description

Responsibilities

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two.

Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members.

Founded in 3, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc.

UHS) in 4. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships.

Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

Learn more at :

Job Summary : The provides supervision of a team in charge of daily, tactical support in all matters related to pharmacy benefits across all lines of business including Commercial fully-insured, self-insured, and Medicare Advantage products.

The position will regularly interface with vendors (including the pharmacy benefit manager), consultants, pharmacies, provider offices, brokers, and members.

The Pharmacy Benefit Operations Manager will lead initiatives related to pharmacy benefits and managing associated personnel, programs, and services.

These initiatives and programs include execution of pharmacy benefits implementation, product development, utilization management, quality improvement, regulatory compliance, and business development projects.

This position will do so by supporting the Director of Pharmacy in coordinating activities among key vendors and internal leadership.

Additionally, this position will be responsible for providing direction and leadership to pharmacy technicians and pharmacy interns.

Finally, this position will provide project management support, human resource management support, and community service support in associated areas of responsibility.

The Pharmacy Benefit Operations Manager will serve as a key subject matter expert in both pharmacy benefit management operations and retail pharmacy operations.

This position will take on advanced responsibilities in regulatory compliance, staff oversight, and training related to all aspects of pharmacy benefits.

This position will also support and / or drive development of plan products, benefit designs, and services. The breadth of responsibilities will vary widely and require a thorough understanding of system processes and financial implications of decisions related to pharmacy benefits.

Benefit Highlights :

• Loan Forgiveness Program
• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans

K) with company match and discounted stock plan

• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its + Subsidiaries! · More information is available on our Benefits Guest Website : benefits.uhsguest.com

About Universal Health Services :

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc.

UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune;

and listed in Forbes ranking of America’s Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.

S. States, Washington, D.C., Puerto Rico and the United Kingdom.

Qualifications

Requirements :

• Preferred : Bachelor’s Degree, equivalent, or higher
• At least five (5) years of experience in the managed care or pharmacy benefit management (PBM) industries.
• At least three (3) years of experience in retail pharmacy operations, as a Certified Pharmacy Technician
• At least five (5) years of experience in supervision of direct reports within a pharmacy-related setting
• Strong Excel, Word, and PowerPoint skills required
• Specialized subject matter expertise in one or more of the following topics required :
• Commercial HMO / PPO / POS
• Medicare Part D
• Retail / Mail Service / Specialty pharmacy
• Pharmaceutical benefit design
• Other facets of pharmaceutical, managed care, and PBM industries

Language Skills :

• Required : strong ability to effectively communicate in English, both verbally and in writing, in a management environment
• Preferred : ability to communicate in Spanish, both verbally and / or in writing

Skills :

• Proven experience in a customer-facing role.
• Excellent communication and presentation skills.
• Must be able to write effectively
• Comfort with both phone and face-to-face communications
• Familiarity with the pharmaceutical, managed care, and PBM industries
• Familiarity with and ability to quickly learn multiple software tools
• Claims Processing Platforms (extensive knowledge required)
• Customer Relations Management (CRM) tools
• Reporting platforms (must be able to write ad hoc queries in at least one reporting tool)
• Intermediate level MS Office skills
30+ days ago