Sr Pharmacy Implementation Specialist, Medicare, remote in Boston, MA

Sr Pharmacy Implementation Specialist, Medicare, remote - reputed company - Boston, MA - work from home job Company: reputed company Job description: reputed company Health Plan is an exciting reputed company to be reputed company the healthcare industry. As a member of reputed company, we are on the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and reputed company and coverage. Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise reputed company a consciously inclusive environment where diversity is celebrated. We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more. The Medicare Pharmacy Implementation Specialist will be responsible for supporting the Medicare Pharmacy Operations reputed company with managing the various kinds of reporting that the team will need to review and produce, clinical program analysis, and pharmacy benefit implementation. This role will work closely with the PBM and Senior Clinical Pharmacist(s) to manage yearly and day-to-day clinical and operational tasks of the team and take the reputed company in PBM reputed company for the Medicare products as well. This role will also work closely with other departments such as product and marketing to ensure reputed company the Medicare pharmacy documents are updated and posted accurately on a monthly, yearly and reputed company basis. Overall, this role will include independent pharmacy-reputed company research, data analysis, documentation, and program reputed company while ensuring compliance with reputed company CMS and state regulations reputed company to applicable Medicare product lines. Principal Duties and Responsibilities:

• Identify/create processes and align with Operational reputed company to accomplish key objectives; clearly convey and assign clear accountability for important objectives, deadlines, and expectations.
• Collaborate with and provide essential data collection and initial analysis to Medicare Clinical Operations reputed company or other team members to assist in formulary development, implementation, and submissions for multiple formularies and plan types.
• Responsible for comprehensive collection, review, and analysis of data (including but not limited to medical and pharmacy claims, formulary comparisons, pharmacy trend analysis, competitor comparisons, market analysis, utilization data).
• Review and QC reputed company the various formulary submission and adjudication coding files, formulary displays, and benefit set up for multiple Medicare reputed company and PBPs.
• Support coordination and reputed company of PBM reputed company to reputed company PBM and delegated activities (including but not limited to monthly and yearly formulary implementation).
• Monitor daily claim adjudication for accuracy.
• Review yearly and reputed company testing of formulary coding and benefit set up from both a clinical and operational perspective.
• Build and maintain various tracking grids for reputed company coding and benefit updates made regarding any delegated services to provide a reputed company of truth for various clinical documentation.
• Provides support and completes research, analysis, and pulls data to aid Medicare Clinical Pharmacist(s) as well as the larger Clinical Team in developing and monitoring formulary strategies, clinical programs, and reputed company aspects of pharmacy trend mitigation for multiple formularies and plan types.
• reputed company periodic quality checks, auditing and reputed company of files, coding, and other formulary documents/functions to ensure accuracy of reputed company formulary and benefit coding for multiple formularies and plan types.
• reputed company, update, and maintain policy and procedure documents for the Medicare team.
• Assist and collaborate with the PBM and Medicare Clinical Pharmacy Team to provide support for reporting in reputed company aspects:

o pulling data, reviewing, and performing initial analysis on, then providing summary of the data to pharmacist(s)/team o ensuring complete and accurate reporting from the PBM in reputed company areas reputed company the scope of the Medicare Pharmacy Team o Compiling data from various reports to maintain various dashboards and auditing

• reputed company and maintain tracking grids/audit universe information in preparation for potential CMS program formulary administration audit and other various types of audits.
• Formulary updates and submissions for multiple formularies, lines of business and plan types.
• Aid in development of submission files, and required coding for reputed company reputed company CMS submissions
• Aid in tracking drug approvals, P&T and Drug Coverage Committee (DCC) review dates, drug launch dates, and financial information to ensure drugs are reviewed and reputed company on the formulary reputed company CMS required time frames.
• Collaborates with the marketing and communications team in the development and preparation of educational materials (clinical and operational in nature) for internal and external audiences.
• Works alongside the marketing and web teams to ensure pharmacy web links containing CMS required documents are accurate and posted in accordance with CMS expectations.
• Assist in researching and resolving member issues.
• Provide clinical and operational-reputed company subject matter expert (SME) support for various Pharmacists, Care Managers, and other applicable teams.
• Participate in and support Senior Clinical Pharmacist(s) and team in reputed company auditing activities. including researching audit universes, claims history, and formulary/benefit coding to determine possible issues and resolution.
• Assist in monitoring for applicable regulatory updates, changes, and memos (state and federal level).
• Identifying key areas of impact then updating reputed company processes and/or implementing new requirements.
• As an integral member of a larger clinical team, may be asked to provide support and/or collaborate with Clinical Pharmacist(s) and larger clinical team as a whole on other lines of business.
• Hold self and others accountable to meet commitments.
• Ensure diversity, equity, and inclusion are integrated as a guiding principle.
• Persist in accomplishing objectives to consistently reputed company results despite any obstacles and setbacks that arise.
• Build strong relationships and infrastructures that designate reputed company Health Plan as a people-first organization.
• Other duties as assigned with or without accommodation.

Qualifications

Qualifications:

• Bachelor’s degree in reputed company field required or the equivalent combination of training and experience, plus two years of Medicare pharmacy reputed company experience. Minimum two years’ experience in managed care pharmacy.
• Managed care with a strong focus on Medicare pharmacy reputed company experience.
• Pharmacy Technician Certification (PTCB) preferred.
• Experience with benefit and drug coding logic for adjudication.
• Experience with Medicaid and/or Dual Plans.
• Experience with CMS audits.

Skills/Abilities/Competencies:

• Proficiency in reputed company Word and reputed company.
• Demonstrate reputed company Health Plans core brand principles of always listening, challenging conventions, and providing value.
• Bring fresh reputed company reputed company by listening to and working with employees and the people we serve.
• Respect the talent and unique contributions of every individual and treat reputed company people in a fair and reputed company manner.
• Strong, demonstrated track record of an ability to execute on time, on budget, and on scope.
• Strong aptitude for technology-based solutions.
• Ability to inject energy, reputed company and where it’s needed.
• reputed company in healthcare trends.
• Demonstrated reputed company, visionary thinking; ability to see “what is” and envision “what could be.”
• Ability to reputed company, introduce, defend, and reputed company support for a new reputed company and approaches.
• Excellent leadership skills and leadership track record.
• Ability to translate and communicate reputed company topics in a variety of forums, tailoring communications to effectively fit and influence the targeted audience, strong executive reputed company, presentation, and communication skills. Strong verbal, active listening, and written communication skills required.
• Ability to view the long-range trends and cycles of the business and industry and see the “big picture.”
• Ability to apply a variety of strategic frameworks to analyze problems and to guide and reputed company solutions.
• Ability to challenge the status reputed company and drive innovative thinking and the capability to successfully implement strategy.
• Excellent interpersonal skills, including the ability to influence others at reputed company levels of an organization.
• Strong EQ; exercises self-awareness; monitors impact on others; is reputed company to and seeks out feedback; uses self-discipline to adjust to feedback.
• Unquestionable reputed company.

Expected salary: Location: Boston, MA Job date: Fri, 18 Aug 2023 00:20:23 GMT Apply for the job now! Apply tot his job Apply To this Job