Pay Range: $57,629 - $88,159

Note: Individuals typically begin between the minimum to middle of the pay range

Provides deep understanding and analysis of HMSA's drug benefits which allows the ability to assess business and financial impact of new products and benefits.

• Bachelor's degree and three years of related work experience; or an equivalent combination of education and related work experience.

• Knowledge of health care industry trends.

• Intermediate knowledge in Microsoft Office applications, including Word, Excel, and Outlook.

• Support the pharmacy strategy from a Commercial drug benefit design and delivery perspective.
  
  • Maintain a deep understanding of Commercial drug benefits.
  • Work with internal HMSA staff to ensure HMSA Commercial drug plans are competitive and compliant.
  • Collaborate with other departments including MPD, Fed87 and CPO to assess new contractual and plan requirements and determine implementation needs for compliance.
  • Review and assessment of utilization and drug spend to identity opportunities.

• Benefit Design and Delivery
  
  • Work with internal HMSA staff to understand the intent of the update/change requested. Work with the Pharmacy Benefit Manager (PBM) to implement the change.
  • Analyzes business problems, including, but not limited to new benefit changes or products, formulary changes, enhancements to add functionality and/or redesigns of systems to improve efficiency.
  • Implement, test, and evaluate changes made within the PBM.
  • Defines acceptance testing criteria and ensure that the criteria are met before system changes are implemented.
  • Maintain PBM system functionality to ensure operational efficiency.
  • Monitor and evaluate accuracy of pharmacy drug benefit through testing review and validations; report monitoring and/or live claim review.
  • Ensure HMSA meets performance standards state by employer groups, Blue Cross Blue Shield Association, or government regulations, in addition to internal policies, procedures, workflows or business requirements

• AMS Support
  
  • Triage, track and respond to inquiries to ensure servicing needs are properly identified and addressed.
    
    • Identify areas for improvement.
  • Support AMS with employer group reporting needs and asks.
  • Provide RFP Support.
    
    • Work with PM staff to address and respond to RFP questions

• Project Coordination & Implementation
  
  • Manage projects related to implementing clinical initiatives and/or pharmacy benefit operations and improvements.
  • Review and edit requirements, specifications, business processes and recommendations related to proposed solution.
  • Provide quality, objective, and professional analysis of business needs and PBM capabilities/limitations.
  • Conducts research, evaluation of measures and value assessments of initiatives and/or programs.
  • Coordinates and facilitates planning, tracking, and installation of business requirements.
  • Assess compliance with Federal and State regulations, internal policies, procedures, and workflows

• Manage inquiries coming to Pharmacy Management
  
  • Triage, track and respond drug plan inquiries to ensure member servicing needs are properly identified and addressed.
  • Coordinates problem solving associated with inquiries.
  • Performs QI efforts to identify gaps and opportunities for improvement.

• Performs all other miscellaneous responsibilities and duties as assigned or directed