The Manager, Pharmacy Operations will assist in managing the PBM relationship and related operational activities to support clinical and non-clinical deliverables. This position will develop an oversight structure of processes or activities of the PBM, all pharmacy vendors, and internal stakeholders. This oversight structure will include the establishment of KPI’s and program dashboards to measure PBM performance.

ROLE RESPONSIBILITIES

1. Establish, manage, and oversee the process for member and prescriber communications including, but not limited to letters, campaigns, and regulatory postings.
2. Develop and manage project plans for PBM, internal stakeholder, or external vendor initiatives to ensure an accurate, timely and highly coordinated implementation.
3. Define and document corporate oversight processes, policies, and procedures for all delegated pharmacy functions including those intended to identify risk and internal controls.
4. Intake, manage, and resolve inquiries, issues, audits, or requests for information that may come from members, stakeholders, states, CMS and/or any other channel.
5. Assist in managing the PBM relationship for Bright Health and affiliate plans with a focus on all non-clinical PBM deliverables.
6. Establish and own the readiness of materials for new implementations and annual readiness activity.
7. Establish PBM KPIs and Program dashboards to manage and measure outcomes related to performance guarantees.
8. Develop oversight structure to be implemented for the PBM(s) and all pharmacy vendors. This includes claims payment, rebate administration, pharmacy network adequacy, customer service, utilization management, appeals, and quality/Part-D Stars support.
9. Help prepare and disseminate dashboards and/or reporting associated with Pharmacy compliance, PBM oversight, financial and plan performance, claims payment and accuracy, utilization management, customer service, rebates, and operational performance.
10. Draft and maintain administrative pharmacy policies related to core job responsibilities.
11. Support claims platform or PBM transitions as they come up in the usual course of business. This entails business requirements, benefit build, testing, and oversight of benefit install.
12. As required, present PBM performance dashboards to senior leaders of Bright Health
13. Collaboratively work with both clinical and non-clinical areas within Bright.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
• Bachelor’s in Science Degree required, Doctor of Pharmacy Degree preferred.
• Ten (10) years of professional experience in Pharmacy at a health plan or PBM.
• Five (5) years of project management/relationship management experience required, preferably in the pharmacy or healthcare industry preferred.
• Five (5) years of experience in triaging and resolving inquiries associated to claims and benefits.
• Six-Sigma Certification preferred.

PROFESSIONAL COMPETENCIES
• Able to formalize and lead vendor implementation with project management tactics and tools.
• Capability to manage an extensive materials library from the development to fulfillment and with a great level of attention to detail.
• 100% team player and ability to collaborate effectively with others to achieve common goals.
• Able to multi-task and set priorities with strong organization and problem-solving skills supporting and enabling sound decision-making.
• Advanced Excel and PowerPoint skills to create Executive Level schedules and presentations.
• Strong analytic and critical thinking skills to resolve complex situational issues requiring design of processes which are lean, repeatable and comprehensive.
• Self-starter that can develop and execute on a plan to address ambiguous situations or ones with limited direction.
• Exceptional attention to detail.
• Excellent customer service and communication skills.
• Excellent written and verbal communication skills; ability to provide clear and concise information to senior leaders.
• Comfortable following timeline driven workplans and managing multiple projects; thrive in collaborative environments.

WORK ENVIRONMENT
The majority of responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer. Travel may be required.