Pharmacy Analyst (Remote)

Highmark Health; Pennsylvania; Remote; USD 57,000 - 108,000; Full time

Job summary

An established industry player is seeking a dynamic individual to join their Pharmacy Medicaid/DSNP business unit. This role involves leading projects, analyzing data to identify trends, and developing innovative pharmacy services. You will work closely with various stakeholders to ensure compliance and enhance program effectiveness. The position promises a collaborative environment where your contributions will directly impact business growth and member satisfaction. If you are passionate about healthcare and project management, this opportunity is perfect for you.

Qualifications

• Healthcare and project management experience required.
• Bachelor's degree preferred for advanced roles.

Responsibilities

• Manage projects to meet business objectives and improve processes.
• Collaborate with stakeholders to develop pharmacy benefit solutions.

Skills

MS Office

Critical Thinking

Presentation Skills

Problem Solving

Communication Skills

Education

High School Diploma / GED

Bachelor's Degree

Job description

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

Work with the Pharmacy Medicaid/DSNP business unit business owners, stakeholders and other management, as required, to achieve the Pharmacy Medicaid/DSNP business unit growth objectives. Organize and coordinate the Pharmacy Medicaid/DSNP business unit 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. Responsible for 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 Medicaid/DSNP service or programs, perform appropriate research/analyses, and evaluate feasibility of the administration and implementation of the programs.
• 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 andadvanced analytic support, developing predictive models and forecasts to identify trends, opportunities, and potential risks. Collaborate with stakeholders to translate these insights into actionable business strategies.
• 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 Medicaid/DSNP business unit applications and/or analyzes change requests/enhancements in existing Pharmacy Medicaid/DSNP business unit 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

Required

• High school diploma / GED

Substitutions

• None

Preferred

• Bachelor's Degree

EXPERIENCE

Required

• Healthcare experience
• Project Management experience

Preferred

• Project Management

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%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

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.

Pay Range Minimum:

$57,700.00

Pay Range Maximum:

$107,800.00

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

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.

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