Pharmacy Operations Specialist III, Benefits at Kaiser… · Reno

Job Summary:

In addition to the responsibilities listed below, this position is responsible for using a working knowledge of pharmacy benefits to work with pharmacy and health care professionals to improve member service, affordability, and access; assisting the implementation of benefits across necessary business lines (e.g., Commercial, Medicare, Self-funded, Exchanges, Medicaid) and determining benefit compliance with federal regulations and legislation; solving standard related to administrative activities including management of vendors, claim adjudication, audits, network management, drug pricing, and sales support including request for proposals; assisting the facilitation of benefit training for health plan staff and external audiences with a focus on federal and regulatory compliance; suggesting improvements for the design, development, modification and implementation of new and current pharmacy benefits.

Essential Responsibilities:

• Pursues effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and members. Listens to, seeks, and addresses performance feedback; provides mentoring to team members. Pursues self-development; creates plans and takes action to capitalize on strengths and develop weaknesses; influences others through technical explanations and examples. Adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; helps others adapt to new tasks and processes. Supports and responds to the needs of others to support a business outcome.
• Completes work assignments autonomously by applying up-to-date expertise in subject area to generate creative solutions; ensures all procedures and policies are followed; leverages an understanding of data and resources to support projects or initiatives. Collaborates cross-functionally to solve business problems; escalates issues or risks as appropriate; communicates progress and information. Supports, identifies, and monitors priorities, deadlines, and expectations. Identifies, speaks up, and implements ways to address improvement opportunities for team.
• Independently provides support to pharmacy and healthcare professionals by: leveraging systems related to analytics and informatics to support relevant patient-facing teams; collaborating with meetings and relevant committees to support front-line operations; and exercising a patient focus throughout ones technical expertise and activities and identifying patient related issues, challenges, possible improvements and taking action to ensure the downstream patient impacts are being followed up on.
• Supports various functions within operations and may support operations in a specific area by: collaborating with interdisciplinary teams to implement pharmacotherapy safety practices and initiatives; implementing pharmacy operations initiatives and programs that directly support the day to day functioning of a specified set of pharmacies or locations and coordinates with relevant groups on the rollout, staffing, education, etc. requirements; and supporting operational needs (e.g., workflow management, policy management, systems improvement, etc.) and ensuring policy compliance.
• Contributes to service, affordability, people, quality of care, and regulatory pharmacy goals by: coordinating efforts to create, design, and help implement strategic plan to support improvements to service, quality, people, affordability, and regulatory initiatives; evaluating data trends from tools and dashboards to support implementation of new programs and initiatives; reviewing and influencing others to conduct sweeps of new laws and rules from regulatory agencies and ensures application into operations (e.g., FAQs to markets); contributing to the building and socializing of new tools to promote awareness and use; evaluating accuracy of inputs into accountability dashboard to ensure rules are followed; and aligns own operations goals to key affordability metrics.
• Begins to serve as a subject matter expert for quality improvement processes and regulations within assigned area by: maintaining awareness of current internal policies and relevant external laws, regulations, and standards and serves as a source of expertise within certain defined areas; coordinating sub-projects on committees that provide input and guidance on various improvement initiatives; developing, conducting, coordinating, and beginning to identify quality improvements related to medication safety for assigned clinical area; researching and reporting related material; identifying issues and escalating to engagement manager/sponsor to resolve; leveraging basic knowledge of drugs and their uses and how they impact clinical practices; guiding members, patients and/or healthcare providers to understand appropriate use and application of prescribed medication and providing drug information to relevant healthcare providers; leveraging standard application of strategy to ensure achievement of member financial and therapeutic objectives; and monitoring member data to help assess plan outcomes.

Minimum Qualifications:

• Minimum two (2) years of experience in Pharmacy Benefits.

• Doctorate of Pharmacy or equivalent degree (e.g., Bachelors of Pharmacy from a School of Pharmacy).

• Pharmacist License (from any state) required at hire

• Pharmacist License (Nevada) within 12 months of hire

Preferred Qualifications:

• Two (2) years of experience working in a large matrixed organization.
• One (1) year of experience in project management.

Click here for Important Additional Job Requirements.

Share this job with a friend

You may also share this job description with a friend by email or social media. All the relevant details will be included in the message. Click the button labeled Share that is next to Submit.