Pharmacy Operations Analyst

HMSA; Honolulu (HI); Hybrid; USD 90,000 - 120,000; Full time

Job summary

HMSA is seeking an experienced professional to lead operational planning and execution within Pharmacy Operations, PBM, and related areas in a hybrid Honolulu setting. The role focuses on improving efficiency, coordinating testing, and driving issue resolution across cross-functional teams.

The position emphasizes collaboration with internal departments and external partners to implement corrective actions and optimize beneficiary and member services in a dynamic health plan environment.

Responsibilities

• Manage projects related to developing and improving Pharmacy Operations, coordinate and/or facilitate planning and completion of quality assurance and monitoring activities within the department, Pharmacy Benefits Manager (PBM) and/or among major functional areas
• Assess compliance with internal policies, procedures and work flows and new and revised business requirements; work with internal and external departments to implement corrective actions as necessary to meet and/or maintain acceptable performance levels
• Support day-to-day execution of pharmacy operational activities within an assigned line of business.
• Coordinate operational tasks, implementations, and follow-up activities across internal teams and external partners.
• Assist in planning and execution of pharmacy-related initiatives, benefit changes, and operational enhancements.
• Monitor operational activities to identify risks, delays, and/or process breakdowns.
• Analyze business problems, including, but not limited to new benefit changes or products, formulary changes, enhancements to add functionality and/or improve efficiencies
• Support benefit setup, validation, testing, and implementation activities.
• Review benefit configuration outcomes and investigate discrepancies or operational concerns.
• Coordinate testing activities with internal stakeholders and external vendors.
• Document implementation results, findings, and required corrective actions.
• Investigate operational issues impacting members, pharmacies, and/or business partners.
• Facilitate & Coordinate issue resolution efforts across Pharmacy Management teams and supporting departments.
• Identify root causes, escalation needs, and opportunities for process improvement.
• Develop recommendations and proposals for resolution for leadership
• Track operational issues through resolution and communicate status updates to stakeholders.
• Independently analyze operational trends, implementation results, issue patterns, and performance indicators.
• Develop reports and summaries that support decision-making and continuous improvement.
• Partner with Pharmacy Performance and Pharmacy Solutions to support operational reviews and initiative tracking.
• Identify opportunities to improve workflow efficiency and service quality.
• Partner with Operations Specialists to ensure operational activities are completed accurately and consistently.
• Collaborate with Operations Pharmacists on clinically complex operational issues.
• Support interactions with internal departments, external vendors, and PBM partners.
• Contribute operational expertise to enterprise initiatives and governance discussions as needed.
• Performs all other miscellaneous responsibilities and duties as assigned or directed.

Job description

1. Operational Planning & Execution

   • Manage projects related to developing and improving Pharmacy Operations, coordinate and/or facilitate planning and completion of quality assurance and monitoring activities within the department, Pharmacy Benefits Manager (PBM) and/or among major functional areas
   • Assess compliance with internal policies, procedures and work flows and new and revised business requirements; work with internal and external departments to implement corrective actions as necessary to meet and/or maintain acceptable performance levels
   • Support day-to-day execution of pharmacy operational activities within an assigned line of business.
   • Coordinate operational tasks, implementations, and follow-up activities across internal teams and external partners.
   • Assist in planning and execution of pharmacy-related initiatives, benefit changes, and operational enhancements.
   • Monitor operational activities to identify risks, delays, and/or process breakdowns.

2. Benefit Implementation & Testing Support

   • Analyze business problems, including, but not limited to new benefit changes or products, formulary changes, enhancements to add functionality and/or improve efficiencies
   • Support benefit setup, validation, testing, and implementation activities.
   • Review benefit configuration outcomes and investigate discrepancies or operational concerns.
   • Coordinate testing activities with internal stakeholders and external vendors.
   • Document implementation results, findings, and required corrective actions..

3. Issue Resolution & Process Improvement

   • Investigate operational issues impacting members, pharmacies, and/or business partners.
   • Facilitate & Coordinate issue resolution efforts across Pharmacy Management teams and supporting departments.
   • Identify root causes, escalation needs, and opportunities for process improvement.
   • Develop recommendations and proposals for resolution for leadership
   • Track operational issues through resolution and communicate status updates to stakeholders.

4. Operational Analysis & Reporting

   • Independently analyze operational trends, implementation results, issue patterns, and performance indicators.
   • Develop reports and summaries that support decision-making and continuous improvement.
   • Partner with Pharmacy Performance and Pharmacy Solutions to support operational reviews and initiative tracking.
   • Identify opportunities to improve workflow efficiency and service quality.

5. Cross-Functional Collaboration

   • Partner with Operations Specialists to ensure operational activities are completed accurately and consistently.
   • Collaborate with Operations Pharmacists on clinically complex operational issues.
   • Support interactions with internal departments, external vendors, and PBM partners.
   • Contribute operational expertise to enterprise initiatives and governance discussions as needed.
6. Performs all other miscellaneous responsibilities and duties as assigned or directed.

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