Manager, Pharmacy Operations 8/22/2020
Johns Hopkins Health Care
JOB DESCRIPTIONAPPLY MANAGER, PHARMACY OPERATIONS
Requisition #: 275104
Location: Johns Hopkins Health Care, Hanover, MD 21076
Work Shift: Day Shift
Work Week: Full Time (40 hours)
Weekend Work Required: No
Date Posted: Aug. 21, 2020
Johns Hopkins HealthCare (JHHC) is the managed care and health services business of Johns Hopkins Medicine, one of the premier health delivery, academic, and research institutions in the United States. JHHC is a $2.5B business serving over 400,000 lives with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHC has become a leader in provider-sponsored health plans and is poised for future growth.
Many organizations talk about transforming the future of healthcare, Johns Hopkins HealthCare is actually doing it. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for the members and communities we serve. If you are interested in improving how healthcare is delivered, join the JHHC team.
The Manager, Pharmacy Operations is responsible for planning, managing and organizing the functions of the pharmacy prior-authorization unit to ensure all contract requirements and business initiatives are completed successfully and timely. Other responsibilities include management and evaluation of all non-clinical departmental functions, pharmacy vendors in regard to contractual compliance and service standards, resolving escalated internal and external service requests, coordinating the receipt and delivery of regulatory reports, supporting the day to day business relationship, executing and monitoring Letter of Agreements with non-contracted pharmacies. This position will be the primary point of contact for all PBM, vendor, benefit systems, claims, and operational inquiries.
Task requirements for position:
Ensures vendor operations meet the needs of the internal stakeholders and ensure compliance with contracted service level agreements.
Monitors and tracks contract compliance of the PBM, including performance guarantees.
Serves as internal primary point of contact for all PBM, vendor, benefit systems, claims, edits, and operational inquiries.
Troubleshoots, evaluates, educates, and provides resolution and/or guidance as needed.
Investigates, resolves, and communicates the resolution of member complaints with pharmacy vendor and PBM related to accurate and timely processing of claims and membership transactions.
Review and update operational policies and staff compliance with these policies
Monitor operational standards to ensure compliance with regulatory and contractual requirements
Monitors the Eligibility Transmission Process, including coordinating the resolution of error reports.
Directs and manages the implementation of pharmacy communication strategy and coordinates required reporting delivered to DHMH and regulatory agencies
Monitor accuracy of pharmacy related information on JHHC websites
Develop and monitor training program for prior-authorization staff
Analyzes actual results against plan and recommends interventions where appropriate.
Maintains complete documentation including status reporting, scoping documents, and gap analysis of ongoing projects and day to day issues between the health plan and PBM/vendor.
Works cross functionally to provide follow up and advise on vendor work and projects.
Assists management with special reports.
Analyzes operational and vendor generated reports and develop and oversee execution of corrective actions if needed
Bachelor s degree in business management, Healthcare Administration, or related discipline required. Will accept Associate s Degree with current enrollment in a bachelor s program with documented plan for completion.
Prefer a comprehensive understanding of managed care, concepts and principles, and the application of specific JHHC benefit plans.
Comprehensive and expert understanding of a pharmacy prior-authorization unit providing prior-authorization request reviews, customer service and associated functions, such as call center metrics and reporting requirements, and pharmacy utilization metrics
Requires excellent communication, both oral and written, as well as strong interpersonal skills to effectively interface with all internal and external customers.
Requires good analytical ability in order to complete tasks assigned, gather and interpret data from different sources and to resolve complex problems.
Work requires reinforcing quality and customer service standards; analyzing and resolving quality and customer service issues; identifying trends, and recommending procedural and process improvements
Requires excellent leadership skills, including the ability to prioritize, problem-solve and multi-task in a fast-paced environment.
Requires the ability to handle sensitive and confidential information; communicate and exchange information with all internal and external customers.
Work requires a comprehensive and expert understanding of an inbound call center, providing customer service and associated functions, such as customer service plus medical/dental claims and benefits.
Work requires a comprehensive and expert knowledge of workforce management activities and reporting.
D. Required Licensure, Certification, Etc.:
E. Work Experience:
Requires a minimum of 5 years of experience in a managed care, business, or healthcare environment, with demonstrated experience in data analysis, reporting, and project management. Prior PBM experience strongly preferred.
Requires a minimum of 3 years management experience.
F. Machines, Tools, Equipment:
Must be able to operate general office and communications equipment.
A. Budget Responsibility:
Effectively uses resources within control.
B. Authority/Decision Making Level:
Makes decisions regarding work processes based on established guidelines.
Prioritizes and organizes work to meet changing priorities.
Works collaboratively with limited supervision.
C. Supervisory Responsibility:
Manages staff and daily activities of an inbound call center. Has responsibility for the hiring, and accomplishing staff results by communicating job expectations, planning work, monitoring performance and appraising job results; coaching, and performance managing employees; initiating, coordinating, and enforcing systems, policies and procedures. Provides developmental and growth opportunities for staff.
Uses operational metrics and other indicators to analyze staffing needs and department workflows and procedures in order to improve customer service.
Responsible for the proper flow and completion of information from the vendors, as well as using critical thinking skills and defined procedures to resolve problems or issues that arise.
Must be able to compile and communicate Individual staff performance statistics as required in the performance standards and make recommendations for service enhancements or improvement.
Works in normal environment where there are no physical discomforts due to dust, dirt, noise and the like.
Work is sedentary in nature; however, some standing, stooping, and bending is required. The position requires activity, pulling and filing.
Work requires concentration and constant attention to accuracy and detail for extended periods of time.
Johns Hopkins Health System and its affiliates are Equal Opportunity/Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identity, sex, age, national origin, disability, protected veteran status, and or any other status protected by federal, state, or local law.