Company :Gateway Health Plan
Job Description :
This job works with Pharmacy Markets business owners, stakeholders and other management, as required, to achieve Pharmacy Markets growth objectives. Organizes and coordinates Pharmacy Markets activities to focus on the successful delivery of desired results. Monitors and evaluates the progress, status and alignment of activities. Performs corrective action as needed to maintain the viability, relevance and timeliness of the work. Communicates regularly and effectively with customers regarding issues or concerns. Depending on the Pharmacy Markets business unit, may be responsible for one or more of the following:
- Performs research on projects and manage and lead projects to successfully meet business objectives. May manage all size projects (small, medium, large, enterprise). Analyzes data to determine business problem, trends, or opportunities for process improvements.
- Identifies needs to develop new and innovative Pharmacy products, perform appropriate research/analyses, and evaluate feasibility of the administration and implementation of products.
- Partners with business units to ensure compliance with governmental, contractual, and corporate guidelines, regulations, and policies and procedures. Continuously monitors regulatory changes, legislative efforts, industry trends, and/or contract changes.
- Provides consultation and analytic support to assigned functional areas.
- Collaborates with business owners/stakeholders to understand business needs, processes project specifications and business case development. Translates business needs into clearly defined and documented, high quality requirements, functional designs, and system supplemental specifications for new Pharmacy Markets applications and/or analyzes change requests/enhancements in existing Pharmacy Markets applications.
- Implement product/program designs and ensure quality standards, financial performance, and regulations are met.
- Develop and establish standardized processes and effective measurement, evaluation and improvement methods.
- Implement interventions that result in continuous measurable improvements.
- Work collaboratively with business owners to identify areas where improvements are needed and to develop and monitor appropriate action plans to ensure a consistent focus on priority issues. General knowledge of key performance indicators (KPIs) and metrics.
- Analyze data processes, business processes, and interfaces to support multiple areas which will include program (and/or vendor) oversight, using appropriate measurement processes and potential audits.
- Gather and analyze information, designs and test solutions to problems and formulates plans.
- Make decisions that refine and improve known practices or develops new approaches.
- Work with multidisciplinary teams within Pharmacy Markets, other Organizational departments, and external vendors to ensure program effectiveness and general project management.
- Make independent contributions to projects as well as contributes and manages some small to medium projects, when applicable.
- Accountability for escalated or complex issue resolution.
- Develop business and pharmacy benefit solutions to satisfy mutually agreed upon goals and objectives; conduct problem solving resolution and decision making sessions for complex issues and projects; promote a culture of performance excellence and continuous quality improvement.
- Communicate effectively with all levels of the organization.
- Establish routine informational exchanges, based upon proposed product designs, prospective goal setting, strategic planning and implementation activities.
- Identify and articulate problems to management, steering committees and/or project sponsors.
- Research and develop competitive pharmacy benefit offerings and ensure proper positioning in the marketplace.
- Focus on achieving optimal member experience and continued viability of the pharmacy product portfolio.
- Other duties as assigned or requested.
- High school diploma or GED
- 3-5 years of relevant, progressive experience in the area of specialization. Grandfathered experience requirements effective August 2016.
- health care experience
- project management experience
- Pharmacy Knowledge
- SQL or SAS Experience required
- Tableau experience a plus
- Analytical skills
Knowledge, Skills and Abilities
- Advanced experience with MS Office.
- Experience in performing group/meeting presentations to technical/non-technical and customer audiences.
- Strong critical thinking skills.
- Ability to identify and assess patterns, trends, root causes, develop explanations and test solutions.
- Ability to identify and assess problems and solutions, refer to applicable policies, identify options, and recommend appropriate courses of action.
- Excellent verbal and written communication skills.
SCOPE OF RESPONSIBILITY
Does this role supervise/manage other employees?
Is Travel Required?
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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