4 Pharmacy Operations jobs in Marmet

This position will be responsible for the Specialty Pharmacy operations for OAPI
The position will report to Director, Specialty Pharmacy Operations
We are seeking a detail-oriented and proactive Senior Manager of Pharmacy Operations to support the operational execution of our new specialty pharmacy product launch. This role will be primarily focused on managing the day-to-day activities with specialty pharmacy partners, ensuring smooth operations, and addressing any operational issues that arise. The Senior Manager will also collaborate closely with Account Managers, Field Reimbursement Managers, and other internal stakeholders to resolve complex issues, improve processes, and ensure a seamless patient and provider experience.
**Key Responsibilities:**
**Specialty Pharmacy Partner Management:**
+ Oversee and manage day-to-day activities with specialty pharmacy partners, ensuring timely and accurate order fulfillment, inventory management, and patient support services.
+ Serve as the primary point of contact for operational issues, including addressing questions, investigating discrepancies, and driving resolution with pharmacy partners.
+ Monitor and maintain operational performance standards with pharmacy partners, ensuring alignment with agreed-upon service levels, KPIs, and regulatory requirements.
+ Investigate and resolve any challenges related to prescription processing, distribution, patient access, or reimbursement.
+ Create and manage various trade/SP amendments and communications
+ Leverage trade customer contracts, by analyzing and monitoring data to maintain optimal inventory levels.
+ Responsible for creating and updating business rules with each specialty pharmacy
+ Contribute to development of product and channel specific contract strategies
**Collaboration with Internal Stakeholders:**
+ Lead and manage all touchpoints with internal and external parties
+ Work cross-functionally with Market Access on product access issues and Medical team on resource development and pull-through.
+ Develop relationships and work closely with the Patient Experience Liaisons and/or Field Reimbursement Managers to help resolve Patient/Provider access issues.
+ Provide regular updates regarding pharmacy partner performance, patient access issues, and any operational challenges.
+ Collaborate with the team to continuously improve patient services and operational processes, including reviewing and optimizing workflows to enhance the overall customer experience.
**Issue Investigation & Resolution:**
+ Take ownership of investigating operational issues and work with internal and external teams to identify root causes and implement corrective actions.
+ Address challenges related to patient enrollment, medication distribution, insurance verification, or other issues impacting pharmacy operations.
+ Escalate critical issues as needed and ensure effective communication with all relevant parties to resolve problems quickly and efficiently.
**Reporting & Data Analysis:**
+ Collect and analyze operational data related to specialty pharmacy performance, patient access, and service delivery.
+ Identify appropriate metrics and tracking to ensure the right execution and success; analyze procedure volume, trends and growth for the specialty channel.
+ Create, conduct and lead business reviews with each of the SPs.
+ Provide regular reports on operational performance, issue resolution, and process improvements to the Director of Pharmacy Operations.
+ Analyze pharmacy reporting in creating patient, provider, physician, pharmacy and payer data to help improve processes
+ Monitor specialty pharmacy data (ie; Time to First Fill, Conversion Rate, Gap days and Adherence)
**Continuous Improvement:**
+ Participate in regular process improvement initiatives aimed at optimizing pharmacy operations and enhancing the patient experience.
+ Provide input into the development and refinement of training materials, operational procedures, and best practices for working with specialty pharmacy partners.
**Qualifications/ Required**
Knowledge/ Experience, Skills and Educational Qualifications:
**Required/Preferred:**
Pharmacy Degree preferred
**Qualifications:**
+ Bachelors degree from an accredited four-year college or university.
+ At least 3 - 5 years direct experience with pharmaceutical industry with an emphasis on specialty pharmacy experience and patient services.
+ Experience evaluating data sources for insights, specifically specialty pharmacy and patient services data.
+ Strong communication skills, including the ability to communicate the data management subject matter to a non-technical/unfamiliar internal customer.
**Competencies**
**Accountability for Results -** Stay focused on key strategic objectives, be accountable for high standards of performance, and take an active role in leading change.
**Strategic Thinking & Problem Solving -** Make decisions considering the long-term impact to customers, patients, employees, and the business.
**Patient & Customer Centricity -** Maintain an ongoing focus on the needs of our customers and/or key stakeholders.
**Impactful Communication -** Communicate with logic, clarity, and respect. Influence at all levels to achieve the best results for Otsuka.
**Respectful Collaboration -** Seek and value others' perspectives and strive for diverse partnerships to enhance work toward common goals.
**Empowered Development -** Play an active role in professional development as a business imperative.
Minimum $131,153.00 - Maximum $187,550.00, plus incentive opportunity: The range shown represents a typical pay range or starting salary for candidates hired to perform the work. Other elements may be used to determine actual salary such as the candidate's job experience, specific skills, and comparison to internal incumbents currently in role. This information is provided to applicants in accordance with states and local laws.
**Company benefits** : Comprehensive medical, dental, vision, prescription drug coverage, company provided basic life, accidental death & dismemberment, short-term and long-term disability insurance, tuition reimbursement, student loan assistance, a generous 401(k) match, flexible time off, paid holidays, and paid leave programs as well as other company provided benefits.
Come discover more about Otsuka and our benefit offerings; .
**Disclaimer:**
This job description is intended to describe the general nature and level of the work being performed by the people assigned to this position. It is not intended to include every job duty and responsibility specific to the position. Otsuka reserves the right to amend and change responsibilities to meet business and organizational needs as necessary.
Otsuka is an equal opportunity employer. All qualified applicants are encouraged to apply and will be given consideration for employment without regard to race, color, sex, gender identity or gender expression, sexual orientation, age, disability, religion, national origin, veteran status, marital status, or any other legally protected characteristic.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation, if you are unable or limited in your ability to apply to this job opening as a result of your disability. You can request reasonable accommodations by contacting Accommodation Request ( ) .
**Statement Regarding Job Recruiting Fraud Scams**
At Otsuka we take security and protection of your personal information very seriously. Please be aware individuals may approach you and falsely present themselves as our employees or representatives. They may use this false pretense to try to gain access to your personal information or acquire money from you by offering fictitious employment opportunities purportedly on our behalf.
Please understand, Otsuka will **never** ask for financial information of any kind or for payment of money during the job application process. We do not require any financial, credit card or bank account information and/or any payment of any kind to be considered for employment. We will also not offer you money to buy equipment, software, or for any other purpose during the job application process. If you are being asked to pay or offered money for equipment fees or some other application processing fee, even if claimed you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to exercise caution when you receive such an offer of employment.
Otsuka will also never ask you to download a third-party application in order to communicate about a legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo, Gmail, Hotmail, etc, and not from an official Otsuka email address. Please take extra caution while examining such an email address, as the scammers may misspell an official Otsuka email address and use a slightly modified version duplicating letters.
To ensure that you are communicating about a legitimate job opportunity at Otsuka, please only deal directly with Otsuka through its official Otsuka Career website .
Otsuka will not be held liable or responsible for any claims, losses, damages or expenses resulting from job recruiting scams. If you suspect a position is fraudulent, please contact Otsuka's call center at: . If you believe you are the victim of fraud resulting from a job recruiting scam, please contact the FBI through the Internet Crime Complaint Center at: , or your local authorities.
Otsuka America Pharmaceutical Inc., Otsuka Pharmaceutical Development & Commercialization, Inc., and Otsuka Precision Health, Inc. ("Otsuka") does not accept unsolicited assistance from search firms for employment opportunities. All CVs/resumes submitted by search firms to any Otsuka employee directly or through Otsuka's application portal without a valid written search agreement in place for the position will be considered Otsuka's sole property. No fee will be paid if a candidate is hired by Otsuka as a result of an agency referral where no pre-existing agreement is in place. Where agency agreements are in place, introductions are position specific. Please, no phone calls or emails.

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This job is responsible for working with HHO clinical departments in the areas of compliance and process improvement. Serves as a corporate resource regarding accreditation standards, clinical performance and continuous improvement principles. Manages the oversight and development of clinical submissions for regulator inquiries. Oversees development and maintenance of Care Management policies and procedures to ensure accreditation and compliance with NCQA and DMMA requirements. Monitors regulatory changes, industry trends, and contract changes on an ongoing basis. Conducts analysis and oversight of design, development, modification, adaptation, implementation and execution of solutions for improvement of short-term and long-term clinical and operational excellence. Collaborates with various organizational leaders to prepare briefings or reports and conduct data analyses.

ESSENTIAL RESPONSIBILITIES

• Serve as an internal project lead to ensure alignment and consistency in the organization's contractual clinical performance measurement across Care Management.

• Manage and coordinate department activities including but not limited to: policy and procedure development and revision, individual staff audits, and overall operations to ensure compliance to standards and regulations. Serve as the point of contact and Highmark Health Options clinical representative to state regulators.

• Continuously examine processes and procedures to identify opportunities for improvement and refinement.

• Perform internal clinical audits for the purpose of quality assurance, and to assure compliance with respect to regulatory requirements and corporate policies/procedures.

• Recommend and develop corrective action plans to management. Oversee final plan implementation and communication.

• Effectively communicate outcomes, data analysis, complex processes and action plans to division/unit staff, corporate partners across departments and external customers.

• Research federal and state regulations and other regulatory materials, various business requirement contracts and subcontracted delegate entity to ensure compliance.

• Coordinate department accreditation, oversight and compliance activities with regulatory guidelines/agencies, including but not limited to NCQA and DMMA.

• Other duties as assigned or requested.

EXPERIENCE

Required

• 5 years of experience as working in a clinical setting.

• 3 years of experience as case management/managed care (with specific knowledge of quality monitoring, compliance and/or regulatory processes)

• 1 year of experience in evaluating, implementing or revising work processes

Preferred

• 3 years of experience in performing auditing/monitoring functions.

• 3 years of experience in creating tools, training documents and educational materials geared to adult learners.

• 3 years of experience in healthcare/health insurance industry.

SKILLS

• Workforce development and resource management with excellent team building and professional development skills

• Strong leadership, collaboration, and motivational skills

• Staff/project management

• Ability to relate to all levels of management and staff as well as individuals external to the corporation

• Ability to multi task and perform in a fast paced, and often intense environment

• Excellent written and verbal communication skills

• Ability to analyze data, measure outcomes and develop action plans

• Be enthusiastic, innovative and flexible.

• Ability to prioritize work demands and meet deadlines

• Excellent computer and software knowledge and skills

EDUCATION

Preferred

• Bachelor’s degree in business, health care administration, nursing, or other related program.

LICENSES or CERTIFICATIONS

Required

• RN, LCSW, LSW, LPC or related clinical licensure, Within 45 days of hire.

Preferred

• None

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office- or Remote-based

Teaches / trains others

Occasionally

Travel from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

No

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

_As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. _

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

$67,500.00

Pay Range Maximum:

$126,000.00

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.

For accommodation requests, please contact HR Services Online at

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Req ID: J265841

**Company :**
Highmark Inc.
**Job Description :**
**JOB SUMMARY**
This job is responsible for working with HHO clinical departments in the areas of compliance and process improvement. Serves as a corporate resource regarding accreditation standards, clinical performance and continuous improvement principles. Manages the oversight and development of clinical submissions for regulator inquiries. Oversees development and maintenance of Care Management policies and procedures to ensure accreditation and compliance with NCQA and DMMA requirements. Monitors regulatory changes, industry trends, and contract changes on an ongoing basis. Conducts analysis and oversight of design, development, modification, adaptation, implementation and execution of solutions for improvement of short-term and long-term clinical and operational excellence. Collaborates with various organizational leaders to prepare briefings or reports and conduct data analyses.
**ESSENTIAL RESPONSIBILITIES**
+ Serve as an internal project lead to ensure alignment and consistency in the organization's contractual clinical performance measurement across Care Management.
+ Manage and coordinate department activities including but not limited to: policy and procedure development and revision, individual staff audits, and overall operations to ensure compliance to standards and regulations. Serve as the point of contact and Highmark Health Options clinical representative to state regulators.
+ Continuously examine processes and procedures to identify opportunities for improvement and refinement.
+ Perform internal clinical audits for the purpose of quality assurance, and to assure compliance with respect to regulatory requirements and corporate policies/procedures.
+ Recommend and develop corrective action plans to management. Oversee final plan implementation and communication.
+ Effectively communicate outcomes, data analysis, complex processes and action plans to division/unit staff, corporate partners across departments and external customers.
+ Research federal and state regulations and other regulatory materials, various business requirement contracts and subcontracted delegate entity to ensure compliance.
+ Coordinate department accreditation, oversight and compliance activities with regulatory guidelines/agencies, including but not limited to NCQA and DMMA.
+ Other duties as assigned or requested.
**EXPERIENCE**
**Required**
+ 5 years of experience as working in a clinical setting.
+ 3 years of experience as case management/managed care (with specific knowledge of quality monitoring, compliance and/or regulatory processes)
+ 1 year of experience in evaluating, implementing or revising work processes
?
**Preferred**
+ 3 years of experience in performing auditing/monitoring functions.
+ 3 years of experience in creating tools, training documents and educational materials geared to adult learners.
+ 3 years of experience in healthcare/health insurance industry.
?
**SKILLS**
+ Workforce development and resource management with excellent team building and professional development skills
+ Strong leadership, collaboration, and motivational skills
+ Staff/project management
+ Ability to relate to all levels of management and staff as well as individuals external to the corporation
+ Ability to multi task and perform in a fast paced, and often intense environment
+ Excellent written and verbal communication skills
+ Ability to analyze data, measure outcomes and develop action plans
+ Be enthusiastic, innovative and flexible.
+ Ability to prioritize work demands and meet deadlines
+ Excellent computer and software knowledge and skills
**EDUCATION**
**Preferred**
+ Bachelor's degree in business, health care administration, nursing, or other related program.
**LICENSES or CERTIFICATIONS**
**Required**
+ RN, LCSW, LSW, LPC or related clinical licensure, Within 45 days of hire.
**Preferred**
+ None
**Language (Other than English):**
None
**Travel Requirement:**
0% - 25%
**PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS**
**Position Type**
Office- or Remote-based
Teaches / trains others
Occasionally
Travel from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
No
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
**_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._
**_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._
_As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times? In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy?_
_Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._
**Pay Range Minimum:**
$67,500.00
**Pay Range Maximum:**
$126,000.00
_Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Req ID: J265841