Pharmacy Analyst (Medicaid Business Unit - Remote)

Lensa; Juneau (AK); Remote; USD 57,000 - 108,000; Full time

Job summary

A leading healthcare organization is seeking a Pharmacy Analyst in the Medicaid Business Unit. This remote position involves managing projects, analyzing data, and ensuring compliance with regulations. The ideal candidate will have healthcare and project management experience, along with strong analytical and communication skills.

Qualifications

• Healthcare experience required.
• Project Management experience required.

Responsibilities

• Manage projects, analyze data for trends and process improvements.
• Ensure compliance with regulations and policies.
• Develop solutions to meet goals and promote continuous improvement.

Skills

Advanced MS Office

Strong presentation skills

Critical thinking

Excellent verbal communication

Excellent written communication

Education

High school diploma / GED

Bachelor's Degree

Job description

Pharmacy Analyst (Medicaid Business Unit - Remote)

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Company:

Highmark Inc.

Job Summary:

Work with the Pharmacy Medicaid/DSNP Business Unit Business Owners, Stakeholders, and Management to achieve growth objectives. Organize and coordinate activities to focus on successful delivery of results. Monitor progress, evaluate activities, and perform corrective actions as needed. Communicate regularly with customers regarding issues or concerns. Responsibilities include:

• Manage projects of various sizes, analyze data for trends, problems, or opportunities for process improvements.
• Research and develop new Pharmacy Medicaid/DSNP services or programs, evaluate feasibility, and plan implementation.
• Ensure compliance with regulations, policies, and procedures, monitoring changes in legislation and industry trends.
• Provide advanced analytics, develop predictive models, and collaborate with stakeholders to inform business strategies.
• Translate business needs into detailed requirements and specifications for applications and process changes.

Essential Responsibilities:

• Implement product and program designs, ensuring quality, financial, and regulatory standards are met. Develop standardized processes and measurement methods. Collaborate with business owners to identify improvement areas and develop action plans.
• Analyze data and business processes to support program oversight and audits. Design and test solutions, make decisions to improve practices.
• Work with multidisciplinary teams within Highmark and external vendors to ensure program effectiveness. Manage small to medium projects.
• Resolve escalated or complex issues.
• Develop solutions to meet goals, conduct problem-solving sessions, and promote continuous improvement.
• Communicate effectively across all organization levels, articulate problems, and recommend solutions.
• Research and develop competitive pharmacy benefit offerings to enhance member experience and product viability.
• Other duties as assigned.

Education:

• Required: High school diploma / GED
• Preferred: Bachelor's Degree

Experience:

• Required: Healthcare experience, Project Management experience
• Preferred: Project Management

Skills:

• Advanced MS Office experience
• Strong presentation skills for technical/non-technical audiences
• Critical thinking, pattern recognition, problem assessment
• Excellent verbal and written communication

Additional Details:

Travel: 0-25%

Position: Office-based, some training, occasional travel, physical requirements include lifting up to 25 pounds.

Pay Range: $57,700 - $107,800, depending on qualifications and location.

Compliance: Adherence to ethical, legal, and privacy standards, including HIPAA and company policies.