Pharmacy Analyst

Highmark Health; Pittsburgh (Allegheny County); Hybrid; USD 90,000 - 130,000; Full time

Job summary

Highmark Health in Pittsburgh, PA, seeks a skilled Project Manager for Pharmacy Markets to align business objectives with program delivery. You will coordinate activities with owners, stakeholders and management to ensure growth targets are met and projects stay on schedule and within budget.

The role requires strong data analysis, problem solving, and ability to translate business needs into clear requirements.

Qualifications

• Healthcare project management experience preferred.
• Strong analytical and problem-solving skills.
• Excellent communication and collaboration abilities.

Responsibilities

• Implement designs and ensure quality, financial performance, and regulatory compliance.
• Develop standardized processes and measurement methods.
• Implement interventions for continuous improvements.
• Collaborate with business owners to identify improvements and monitor action plans.
• Know KPIs and metrics for program evaluation.
• Analyze data and processes to support program oversight and audits.
• Gather information, designs, and test solutions; formulate plans.
• Make decisions to refine practices and develop new approaches.
• Work with multidisciplinary teams to ensure program effectiveness and project management.
• Contribute to small-to-medium projects and handle escalated issues.

Skills

Project Management

Healthcare

Data Analysis

Regulatory Compliance

Stakeholder Management

Communication

Education

High school diploma / GED

Tools

MS Office

Job description

Job Summary

Work with Pharmacy Markets business owners, stakeholders and other management, as required, to achieve Pharmacy Markets growth objectives. Organize and coordinate Pharmacy Markets activities to focus on the successful delivery of desired results. Monitor and evaluate the progress, status and alignment of activities. Perform corrective action as needed to maintain the viability, relevance and timeliness of the work. Communicate 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: Perform 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. Identify needs to develop new and innovative Pharmacy products, perform appropriate research/analyses, and evaluate feasibility of the administration and implementation of products. Partner with business units to ensure compliance with governmental, contractual, and corporate guidelines, regulations, and policies and procedures. Continuously monitor regulatory changes, legislative efforts, industry trends, and/or contract changes. Provide consultation and analytic support to assigned functional areas. Collaborate with business owners/stakeholders to understand business needs, processes project specifications and business case development. Translate 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.

Essential Responsibilities

• 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 Highmark 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.

Education

• High school diploma / GED Substitutions None

Experience

• Healthcare experience Project Management experience Preferred Project Management Critical analysis and problem resolution skills

Licenses or Certifications

• Required None Preferred Six-Sigma SKILLS 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. Language (Other than English): None

Travel Requirement: 0% - 25%

Position Type Hybrid - This is a hybrid based role in Pittsburgh, PA - 3 days a week onsite - T, W, TH.

Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely

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 job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. 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 any category protected by applicable federal, state, or local law. California Consumer Privacy Act Employees, Contractors, and Applicants Notice Highmark Health is a national, blended health organization that includes one of America’s largest Blue Cross Blue Shield insurers and a growing regional hospital and physician network. Based in Pittsburgh, Pa., Highmark Health’s 35,000 employees serve millions of customers nationwide through the nonprofit organization’s affiliated businesses, which include Highmark Inc., Allegheny Health Network, HM Insurance Group, United Concordia Dental, HM Health Solutions and HM Home & Community Services. Highmark Health’s businesses proudly serve a broad spectrum of health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions.