Description:
Description
SHIFT: Day Job
SCHEDULE: Full-time
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America’s leading health care companies and a Fortune Top 50 Company.
Pharmacist Program Manager
*Open to other locations however, the individual is preferred to live in an Eastern Time Zone area.
The Pharmacist Program Manager is responsible for serving as the primary contact for the BCBS WNY Medicaid pharmacy program.
Primary duties include but are not limited to:
- Represent BCBS WNY Medicaid pharmacy program for the region, externally;
- Face of plan to Government Relations, NYS DOH
- Attend state meetings, respond to email inquiries
- Represent BCBS WNY Medicaid pharmacy program within the health plan and with PBM vendor
- Maintain, enhance and modify components of the pharmacy program as needed to align with health plan goals and pharmacy program national Medicaid best practice
- Prepare and present routine pharmacy program updates within various forums, including but not limited to: quarterly business reviews, regulatory meetings, quality meetings to support accreditation, biweekly trend meetings
- On occasion solve claims issues and complaints with the support of Pharmacy Operations team or Medicaid Account Management team
- Perform routine benefit surveillance to assure benefits are working correcting, optimal penetration of preferred products, low claim reject volumes
- Assure successful implementation of program changes including: state mandates and programs to improve the member and provider experience, contain costs and improve quality of service
- Present and report on Enterprise quality programs that impact the market
- Advocate for plan needs
- Identify, develop, and/or advocate for quality programs that will drive more favorable withhold measures (local, enterprise)
- Report on the productivity and outcomes of clinical quality programs
- Assure appropriate access for health plan staff to RX tools
- Assure all necessary client/vendor accountability reporting is complete, accurate an on time.
- Develop and implement communications to pharmacies, prescribers and members as necessary to improve member and provider experience and reduce cost
Qualifications
Qualifications
- Requires a registered pharmacist; 2 years of managed care pharmacy experience including knowledge of current health care and managed care pharmacy practices; or any combination of education and experience, which would provide an equivalent background.
- Current state license to practice pharmacy as a RPH required.
- Minimum 2 years of managed care pharmacy experience that is NOT RETAIL PHARMACY related preferred
- Proficiency in MS Excel, Power Point, Outlook
- Program Management experience in managed care or other related field
- Must demonstrate proficiency as a key participant in program development, where the program seeks to satisfy regulatory requirements, improve clinical outcomes, quality, cost or other measure.
- Must demonstrate proficiency in clinical/technical communication to business leaders, an ability to communicate messages pertaining to programs and systems using data and other details in a way business leaders can understand
- Professional designation preferred
- Day travel and occasional overnight travel may be required
- Experience with government programs (Medicare/Medicaid) strongly preferred
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.