Pharmacy Operations Specialist III, Benefits
Kaiser Permanente
Description: Job Summary:
In addition to the responsibilities listed below, this position is responsible for using a working knowledge of pharmacy benefits to work with pharmacy and health care professionals to improve member service, affordability, and access; assisting the implementation of benefits across necessary business lines (e.g., Commercial, Medicare, Self-funded, Exchanges, Medicaid) and determining benefit compliance with federal regulations and legislation; solving standard related to administrative activities including management of vendors, claim adjudication, audits, network management, drug pricing, and sales support including request for proposals; assisting the facilitation of benefit training for health plan staff and external audiences with a focus on federal and regulatory compliance; suggesting improvements for the design, development, modification and implementation of new and current pharmacy benefits.
Essential Responsibilities:
Pursues effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and members. Listens to, seeks, and addresses performance feedback; provides mentoring to team members. Pursues self-development; creates plans and takes action to capitalize on strengths and develop weaknesses; influences others through technical explanations and examples. Adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; helps others adapt to new tasks and processes. Supports and responds to the needs of others to support a business outcome.
Completes work assignments autonomously by applying up-to-date expertise in subject area to generate creative solutions; ensures all procedures and policies are followed; leverages an understanding of data and resources to support projects or initiatives. Collaborates cross-functionally to solve business problems; escalates issues or risks as appropriate; communicates progress and information. Supports, identifies, and monitors priorities, deadlines, and expectations. Identifies, speaks up, and implements ways to address improvement opportunities for team.
Independently provides support to pharmacy and healthcare professionals by: leveraging systems related to analytics and informatics to support relevant patient-facing teams; collaborating with meetings and relevant committees to support front-line operations; and exercising a patient focus throughout ones technical expertise and activities and identifying patient related issues, challenges, possible improvements and taking action to ensure the downstream patient impacts are being followed up on.
Supports various functions within operations and may support operations in a specific area by: collaborating with interdisciplinary teams to implement pharmacotherapy safety practices and initiatives; implementing pharmacy operations initiatives and programs that directly support the day to day functioning of a specified set of pharmacies or locations and coordinates with relevant groups on the rollout, staffing, education, etc. requirements; and supporting operational needs (e.g., workflow management, policy management, systems improvement, etc.) and ensuring policy compliance.
Contributes to service, affordability, people, quality of care, and regulatory pharmacy goals by: coordinating efforts to create, design, and help implement strategic plan to support improvements to service, quality, people, affordability, and regulatory initiatives; evaluating data trends from tools and dashboards to support implementation of new programs and initiatives; reviewing and influencing others to conduct sweeps of new laws and rules from regulatory agencies and ensures application into operations (e.g., FAQs to markets); contributing to the building and socializing of new tools to promote awareness and use; evaluating accuracy of inputs into accountability dashboard to ensure rules are followed; and aligns own operations goals to key affordability metrics.
Begins to serve as a subject matter expert for quality improvement processes and regulations within assigned area by: maintaining awareness of current internal policies and relevant external laws, regulations, and standards and serves as a source of expertise within certain defined areas; coordinating sub-projects on committees that provide input and guidance on various improvement initiatives; developing, conducting, coordinating, and beginning to identify quality improvements related to medication safety for assigned clinical area; researching and reporting related material; identifying issues and escalating to engagement manager/sponsor to resolve; leveraging basic knowledge of drugs and their uses and how they impact clinical practices; guiding members, patients and/or healthcare providers to understand appropriate use and application of prescribed medication and providing drug information to relevant healthcare providers; leveraging standard application of strategy to ensure achievement of member financial and therapeutic objectives; and monitoring member data to help assess plan outcomes. Minimum Qualifications:
Minimum two (2) years of experience in Pharmacy Benefits.
Doctorate of Pharmacy or equivalent degree (e.g., Bachelor of Pharmacy from a School of Pharmacy).
Pharmacist License (from any state) required at hire
Pharmacist License (California) within 12 months of hire
Additional Requirements:
Knowledge, Skills, and Abilities (KSAs): Compliance Management
Preferred Qualifications: Two (2) years of experience working in a large matrixed organization. One (1) year of experience in project management. One (1) year of experience developing and delivering presentations to management. Two (2) years of experience consulting in a strategic capacity on highly complex or highly visible projects, programs, or initiatives. One (1) year of experience with pharmacy accounting, including inventory management system or pharmacy revenue system. Two (2) years of accounting experience in a pharmacy operations environment, including accounting reporting to meet regulatory requirements. One (1) year of experience designing effective health communication strategies or products. One (1) year of experience in the delivery of health education. One (1) year of consulting experience in health plan administration. Two (2) years of experience in healthcare operations.
In addition to the responsibilities listed below, this position is responsible for using a working knowledge of pharmacy benefits to work with pharmacy and health care professionals to improve member service, affordability, and access; assisting the implementation of benefits across necessary business lines (e.g., Commercial, Medicare, Self-funded, Exchanges, Medicaid) and determining benefit compliance with federal regulations and legislation; solving standard related to administrative activities including management of vendors, claim adjudication, audits, network management, drug pricing, and sales support including request for proposals; assisting the facilitation of benefit training for health plan staff and external audiences with a focus on federal and regulatory compliance; suggesting improvements for the design, development, modification and implementation of new and current pharmacy benefits.
Essential Responsibilities:
Pursues effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and members. Listens to, seeks, and addresses performance feedback; provides mentoring to team members. Pursues self-development; creates plans and takes action to capitalize on strengths and develop weaknesses; influences others through technical explanations and examples. Adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; helps others adapt to new tasks and processes. Supports and responds to the needs of others to support a business outcome.
Completes work assignments autonomously by applying up-to-date expertise in subject area to generate creative solutions; ensures all procedures and policies are followed; leverages an understanding of data and resources to support projects or initiatives. Collaborates cross-functionally to solve business problems; escalates issues or risks as appropriate; communicates progress and information. Supports, identifies, and monitors priorities, deadlines, and expectations. Identifies, speaks up, and implements ways to address improvement opportunities for team.
Independently provides support to pharmacy and healthcare professionals by: leveraging systems related to analytics and informatics to support relevant patient-facing teams; collaborating with meetings and relevant committees to support front-line operations; and exercising a patient focus throughout ones technical expertise and activities and identifying patient related issues, challenges, possible improvements and taking action to ensure the downstream patient impacts are being followed up on.
Supports various functions within operations and may support operations in a specific area by: collaborating with interdisciplinary teams to implement pharmacotherapy safety practices and initiatives; implementing pharmacy operations initiatives and programs that directly support the day to day functioning of a specified set of pharmacies or locations and coordinates with relevant groups on the rollout, staffing, education, etc. requirements; and supporting operational needs (e.g., workflow management, policy management, systems improvement, etc.) and ensuring policy compliance.
Contributes to service, affordability, people, quality of care, and regulatory pharmacy goals by: coordinating efforts to create, design, and help implement strategic plan to support improvements to service, quality, people, affordability, and regulatory initiatives; evaluating data trends from tools and dashboards to support implementation of new programs and initiatives; reviewing and influencing others to conduct sweeps of new laws and rules from regulatory agencies and ensures application into operations (e.g., FAQs to markets); contributing to the building and socializing of new tools to promote awareness and use; evaluating accuracy of inputs into accountability dashboard to ensure rules are followed; and aligns own operations goals to key affordability metrics.
Begins to serve as a subject matter expert for quality improvement processes and regulations within assigned area by: maintaining awareness of current internal policies and relevant external laws, regulations, and standards and serves as a source of expertise within certain defined areas; coordinating sub-projects on committees that provide input and guidance on various improvement initiatives; developing, conducting, coordinating, and beginning to identify quality improvements related to medication safety for assigned clinical area; researching and reporting related material; identifying issues and escalating to engagement manager/sponsor to resolve; leveraging basic knowledge of drugs and their uses and how they impact clinical practices; guiding members, patients and/or healthcare providers to understand appropriate use and application of prescribed medication and providing drug information to relevant healthcare providers; leveraging standard application of strategy to ensure achievement of member financial and therapeutic objectives; and monitoring member data to help assess plan outcomes. Minimum Qualifications:
Minimum two (2) years of experience in Pharmacy Benefits.
Doctorate of Pharmacy or equivalent degree (e.g., Bachelor of Pharmacy from a School of Pharmacy).
Pharmacist License (from any state) required at hire
Pharmacist License (California) within 12 months of hire
Additional Requirements:
Knowledge, Skills, and Abilities (KSAs): Compliance Management
Preferred Qualifications: Two (2) years of experience working in a large matrixed organization. One (1) year of experience in project management. One (1) year of experience developing and delivering presentations to management. Two (2) years of experience consulting in a strategic capacity on highly complex or highly visible projects, programs, or initiatives. One (1) year of experience with pharmacy accounting, including inventory management system or pharmacy revenue system. Two (2) years of accounting experience in a pharmacy operations environment, including accounting reporting to meet regulatory requirements. One (1) year of experience designing effective health communication strategies or products. One (1) year of experience in the delivery of health education. One (1) year of consulting experience in health plan administration. Two (2) years of experience in healthcare operations.
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