Job Details

Operations

Continuously and proactively assess and monitor pharmacy operations performance to achieve contractual targets on a daily basis. Frequently interface with counterparts across the organization to continuously identify and communicate opportunities for improvement with claims, pharmacy customer service and pharmacy core processes. Identify opportunities for improvements in business and operational areas; provide appropriate action plans, develop and implement pharmacy Operations performance analysis programs and metrics to improve operational efficiency. Continuously identify opportunities for improvement and trends via proactive assessment.

Responsibilities

• Assess and monitor performance of vendors for the pharmacy ops process to meet contractual and compliance requirements and align with EmblemHealth customer experience objectives and enterprise goals.
• Conduct reviews, transactional audits, and compliance and operational procedure reviews.
• Work with business partners to define, design and develop analytic and process solutions to improve operations performance and quality; identify, gauge and mitigate risks, through timely, accurate and consistent understanding of impact within operational area and across the organization and to customers.
• Analyze pharmacy ops performance and quality data to understand intended versus actual outcomes and evaluate performance and quality controls and tools to assess effectiveness in identifying errors in processes and systems.
• Communicate results to pharmacy Operations management via reports and presentations.
• Maintain meticulous audit and other assessment records to baseline historical performance and track and trend over time.
• Document special variation events that impact performance as well as corrective action taken to address issues.
• Support pharmacy Operations leadership as needed to conduct ad-hoc assessments and assignments.
• Perform related tasks as directed, assigned, or required.

Qualifications

• Bachelor's degree.
• 3 5+ years of relevant, professional work experience (Required)
• 2+ years of auditing and assessment experience (Required)
• Additional experience/specialized training may be considered in lieu of degree requirement (Required)
• Ability to effectively utilize appropriate metrics to determine performance accuracy/outcomes (Required)
• Excellent collaboration skills and the ability to influence management decisions (Required)
• Strong auditing skills that can be applied across all types of business areas (Required)
• Proficient with MS Office - Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc. (Required)
• Strong communication skills - verbal, written, presentation, interpersonal with all types/levels of audiences (Required)