Manager, Pharmacy Benefits

Job Description

Job Description

About Us :

Building Services 32BJ Benefit Funds ( the Funds ) is the umbrella organization responsible for administering Health, Pension, Retirement Savings, Training, and Legal Services benefits to over 100,000 SEIU 32BJ members.

Our mission is to make significant contributions to the lives of our members by providing high quality benefits and services.

Through our commitment, we embody five core values : F lexibility, I nitiative, R espect, S ustainability, and T eamwork ( FIRST).

By following our core values, employees are open to different and new ways of doing things, take active steps to improve the organization, create an environment of trust and respect, approach their work with the intent of a positive outcome, and work collaboratively with colleagues.

The 32BJ Health Fund is a multiemployer labor-management fund that provides health benefits to members of SEIU Local 32BJ and their dependents.

The Fund is self-insured and is responsible for efficiently managing its resources. To ensure that the Fund can deliver cost-effective high-quality care, the Fund has embraced innovative purchasing strategies that encourage plan participants to use high quality primary care and other cost-effective benefits and providers.

The Fund dedicates significant resources to actively managing its plans and provider networks to operationalize this strategy.

The Fund also invests in innovative policy solutions that will lower healthcare costs for the Fund and its plan participants.

For 2023 and beyond, we will continue to drive innovation, equity, and technology insights to further help the lives of our hard-working members and their families.

We use cutting edge technology such as : M365, Dynamics 365 CRM, Dynamics 365 F&O, Azure, AWS, SQL, Snowflake, QlikView, and more.

Through this technology investment, we have gathered and analyzed thousands of data insights to influence health insurance legislation and propose new health policy.

Our efforts have galvanized many leaders, and the consensus is there is plenty more work to be done.

Please take a moment to watch our video to learn more about our culture and contributions to our members : youtu.be / hYNdMGLn19A

To learn more about the 32BJ Health Fund initiatives, please visit : 32BJ Health Fund Insights

Summary :

The Manager of Pharmacy Benefits provides operational support to Assistant Director, Pharmacy and Ancillary Benefits (PAB) in strategic vendor relationships, day-to-day oversight, and performance accountability of the Health Fund’s pharmacy vendor(s), as well as managing vendor and Health Fund projects as necessary.

Oversight of the vendors includes delivery of exceptional customer service, plan and regulatory compliance, operational monitoring of the contracts for compliance, and operational measurement of the vendors’ performance including analysis and recommendations based on reporting and performance guarantees.

Principal Duties and Responsibilities :

• Pharmacy Benefits Vendor Management
• Works with Assistant Director, PAB to evaluate, modify and maintain vendor relationships
• Works with vendor and internal partners to develop, prepare, and analyze vendor production reports. This includes documenting submission, reviewing trends, identifying outliers, comparing data to data compiled by the Health Fund’s Analytics team, and working with business partners to recommend reporting improvements as needed
• Meets regularly with vendors to monitor progress on open items, review trends, and continue to develop relationships
• Assists with the development and implementation of special projects which are meant to improve health outcomes and reduce the cost of providing ancillary benefits.
• Works with vendor and PAB team to resolve member issues timely
• Development enhancements to processes based on common and recurring inquiries and complaints
• Assists Assistant Director, PAB to monitor pharmacy vendor(s) and ensure that key deliverables in oversight program are met and maintained by both vendor and by the Health Fund staff
• Assists Assistant Director, PAB with quarterly and / or annual meetings to include preparing agenda, maintaining meeting minutes, tracking action plans, and following up on key deliverables.
• Assists Assistant Director, PAB with setting of annual strategic goals for the vendor
• Works with vendor and internal partners to develop, prepare, and analyze vendor production reports. This includes documenting submission, reviewing trends, identifying outliers, comparing data to data compiled by the Health Fund’s Analytics team, and working with business partners to recommend reporting improvements as needed.
• Works with vendors to track performance guarantees, identify deficiencies, and create and track corrective action plans as required
• Pharmacy Benefits and Incident Management
• Collaborates with Assistant Director, PAB and the vendor to identify issues that arise during the course of the day-to-day functioning of the vendor relationship
• Reviews benefits and issues to recommend changes, enhancements and / or solutions and assists in the development of corrective action plans
• Identifies opportunities for benefit enhancements, in partnership with the vendor, that will improve the clinical outcomes of 32BJ members and reduce costs
• Maintains, tracks and ensures timely vendor follow-up on issues identified
• Assists Assistant Director PAB to design and implement benefit changes, including documentation and testing of changes.
• Communication
• Communicate directly with the vendors verbally and in writing to identify and resolve issues and plan design questions
• Initiate and partner with communications to author necessary communications to appropriate 32BJ Health Fund staff that detail and explain health plan modifications
• Communicates necessary health plan modifications to vendor via tool developed and ensures return of completed and signed document confirming modifications have been coded in their respective systems.

Assists in cross-departmental implementations.

• People Management
• Direct supervision of staff member(s), responsible for identifying goals, managing workload, and prioritizing work
• Prioritizes work efforts to ensure the right work is being done by your member(s) of the team
• Develop team member(s) through performance and development plans that focus on the strengths of the individual and areas for opportunity
• Maintains quality service to vendors and internal partners by ensuring team meets performance requirements
• Project Management
• Oversees all aspects of projects including working with other departments to set deadlines, assign responsibilities and monitor and summarize progress of project
• Prepares reports for upper management regarding status of project
• Identifies dependencies within the organization to ensure all aspects of each project are clearly documented and implemented appropriately
• Liaises with vendors, as necessary, including monitoring of vendor deliverables, reviewing testing, and ensuring successful implementation of project
• Performs other relevant duties as assigned by senior management

Qualifications and Core Competencies : To perform the job satisfactorily, an individual must be able to perform each essential duty satisfactorily.

The requirements listed below are representative of the knowledge, skill and / or ability required.

• 3+ years experience in pharmacy benefit management (PBM), pharmacy benefit administration (PBA), or specialty pharmacy management
• Prior experience in negotiating pharmacy drug prices, formulary management, prescription drug claims, mail-order pharmacy services, medical drug utilization review, cost containment strategies, disease management for prescription drug benefits, pharmacy drug rebate management, or similar specialties
• Prior experience managing, developing, and inspiring staff
• Strong project management experience
• Proficiency in data analysis, reporting, and data visualization
• Excellent communication skills, both oral and written, demonstrated by an ability to coordinate and communicate with internal and external stakeholders
• Excellent MS Office skills including PowerPoint and Excel
• Excellent organizational, negotiation, presentation, critical and analytical thinking, and problem solving skills
• Ability to plan and take initiatives to accomplish objectives in timely fashion
• Ability to prioritize work and meet deadlines
• Ability to work on simultaneous projects with diverse working groups

Language Skills : The ability to read, write, and understand English is essential. Ability to read, write, and understand Spanish is a plus.

Education : Bachelor’s degree in Biology, Pharmacy, Health Sciences or related field, or equivalent work experience in the health insurance industry.