Submission for the position: Senior Manager, Pharmacy Benefit Relation - (Job Number: 1201124)
https://centene.taleo.net/careersection/jobdetail.ftl?job=1201124&lang=en
Senior Manager, Pharmacy Benefit Relation
Position Purpose:
• Manages and provides oversight of pharmacy benefit programs for both Medicare and Medicaid to achieve program optimization, ensuring accurate execution of Health Plan - PBM processes.
• Oversees the development and execution of business processes, and drives implementations and departmental initiatives to ensure expectations are met.
• Works with the PBMs and internal partners to coordinate initiatives that require PBM engagement in pharmacy processing, pharmacy benefit administration, data files, and benefit structure.
• Ensures the implementation of initiatives is achieved without setbacks through proper quality assessment measures and planning.
• Works with executives to oversee the project management of all PBM initiatives. Responsible for the PBM eligibility processes, data exchanges with the PBM, reporting, analysis, workflow management, and oversight of the PDE error resolution process.
• Works cross-functionally with other areas of the Pharmacy Department to implement program initiatives.
Essential Functions:
• Responsible for the PBM eligibility processes, data exchanges with the PBM, reporting, analysis, workflow management, and oversight of the PDE error resolution process.
• Leads a team of Pharmacy Benefit Systems Analysts and Project Managers to execute Pharmacy Benefit Relations processes.
• Builds and maintains strong relationships internally and externally, fostering support and a collaborative approach between departments with internal and external stakeholders. This includes, but is not limited to, collaborating with each individual market/region, working closely with other teams in the Pharmacy Department and IT, communicating with the Compliance Department, working with the Project and Integration Management Organizations, partnering with and providing direction to the PBM’s, etc.
• Ensures appropriate setup of all new plans and changes in benefit and copay structure.
• Ensures proper loading of membership for prescription benefits from Wellcare enrollment to PBMs.
• Ensures that all processes subject to regulatory requirements are being met
• Provides guidance and training to new associates.
• Leads project management functions impacting the Pharmacy Benefit Relations department and PBMs.
• Executes ad hoc project or reporting requests as needed to support the Pharmacy Department.
Education/Experience:
A Bachelor's Degree in a related field Business, Health Administration, Analytics or equivalent work experience. Master's Degree in HealthCare, Technology, Analytics or Business is preferred. Required 6 years of experience in Pharmacy benefit management, data analytics, Managed Health Care, or Medicare/Medicaid Managed Care with Part D knowledge. 3 years of management experience including leading projects, senior or lead role directing teams required. 4 years of experience in Pharmacy benefit management, data analytics, Managed Health Care, or Medicare/Medicaid Managed Care with Part D knowledge with Master's Degree preferred.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Health Insurance Operations
USA-Florida-Tampa
USA-Texas-Houston
Envolve Pharmacy
Schedule: Full-time Location(s): USA-Florida-Tampa