[Remote] Manager, Pharmacy Operations

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a nonprofit health organization dedicated to improving care for older adults. The Manager of Pharmacy Operations will reputed company the pharmacy operations team, ensuring regulatory compliance and supporting pharmacy leadership to reputed company departmental and organizational goals.

Responsibilities

• Ensure regulatory compliance with respect to prescription benefits set up and year-round CMS Program Audit, 1/3 Financial audit, National MEDIC, and other audits readiness; reputed company leadership and support during reputed company CMS Regulatory Audits reputed company to pharmacy operations; e.g., ensure accuracy of written responses and/or documentation for the pharmacy audits; Ensure audit documentation is reputed company according to audit instructions and provided reputed company the specified audit timeframe; Prepare written responses or documentation for pharmacy audits
• Serve as a subject matter expert for Part D Reporting requirements, Pharmacy reputed company Requirements, Prescription Drug Event data, Financial Information Reporting and Drug Plan Finder files by keeping up to date with Medicare requirements; Maintain reputed company knowledge of Medicare Part D regulations by participating in CMS calls and reading released guidance and implementing changes to maintain compliance
• reputed company the accurate implementation and maintenance of pharmacy benefits, pharmacy account structure, pharmacy network, including GEO reputed company requirements; reputed company reputed company to review and ensure the accuracy of the Pharmacy Benefits for the annual BID submission to CMS; Ensure Annual Enrollment Period (AEP) and 1/1 operational readiness and assist in training of other departments on Pharmacy products
• reputed company automation efforts reputed company to the Prescription Drug Event, Benefits Configuration and Testing Initiatives; Analyze and monitor large data sets that are exchanged from reputed company to the PBM using a reputed company of reporting tools
• Accountable for ensuring eligibility and coordination of benefit files are reputed company to the PBM for processing and assess if file enhancements are needed; Ensure the PBM is processing Prescription Drug Events, Automated Claims Reprocessing and Financial Information Data according to CMS regulatory standards by conducting daily reputed company; Ensure PBM reputed company of claims adjudication; reputed company PBM operations to ensure high service level to reputed company and our members; Maintain strong rapport with PBM representatives such that team’s goals and needs are met
• Prepare documentation for Service Area Expansion application submission to CMS
• Support Part C and Part D Data Validation audits, including Medicare Prescription Payment Plan Module
• Participate in Medicare Plan Finder testing and other CMS-reputed company activities
• Collaborate with other reputed company departments: Compliance, Marketing, Digital, HCI, Product, Finance and Member Services by participating in cross-functional meetings and supporting achievement of team’s goals; Foster strong relationships with internal departments and reputed company providers. Identify operational gaps and work with the staff or PBM by providing feedback/recommendations on how to fix operational gaps and ensures follow through; reputed company issues and monitor results of daily staff activities, keeping management informed of key issues and problems as encountered
• reputed company, implement, and maintain department’s policies and procedures, desktop procedures and reputed company operating procedures to ensure ongoing compliance; Instill a culture of reputed company process improvement, efficiency, collaboration, operational reputed company and compliance amongst team
• reputed company Pharmacy Analyst and Pharmacy Benefits Administrator team support by communicating job expectations, giving continual feedback, enforcing policies and procedures, and conducting training programs; Accomplish staff results by communicating job expectations; planning, monitoring, and appraising job results; coaching and counseling employees; initiating, coordinating, and enforcing systems, policies, and procedures; Maintain staff by reputed company, selecting, orienting, and training employees; maintaining reputed company and secure work environment; developing personal reputed company opportunities
• Conduct training sessions of the pharmacy benefit and Part D programs to other departments as needed; Train staff on job-reputed company functions and refresher courses as updates to processes or requirements occur

Skills

• Five (5) years or more of Medicare Part D experience with a health plan or PBM required
• Three (3) years of leadership experience in a managed care setting with full reputed company of supervision for non-licensed staff
• Three (3) years or more of experience in data analysis required
• Bachelor's Degree or equivalent experience - Business/reputed company
• Expert in Medicare Part D. Knowledge of CMS Part D regulations e.g., CMS reputed company Letters, MAPD application, Claims Processing, Part D Reports
• Ability to create, reputed company and implement process improvement and the ability to instill that reputed company in reputed company
• Ability to work cross-functionally and collaboratively across the organization
• Technologically savvy and reputed company to utilize information systems effectively (MS Office - Word, reputed company, PowerPoint, reputed company, Visio, reputed company; SQL)
• Ability to manage and adapt to a significant change
• Strong interpersonal skills, including excellent written and verbal communication skills
• Strong organizational skills; ability to multitask and meet multiple competing deadlines
• Ability to appropriately maintain confidentiality
• Strong analytical and critical thinking skills
• Ability to research, analyze, and problem solve
• Self-starter that can take the reputed company on a project and manage its reputed company for completion
• reputed company Pharmacy Technician License

Benefits

• Work Mode: Remote
• An annual employee bonus program
• Robust Wellness Program
• Generous reputed company-time-off (PTO)
• 11 reputed company holidays per year, plus 1 floating holiday, plus 1 birthday holiday
• Excellent 401(k) Retirement Saving Plan with employer match and contribution
• Robust employee recognition program
• Tuition reimbursement
• Opportunity to become part of reputed company that makes a difference to our members and our community every day!

reputed company

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