Job Details

Summary of Job

Continuously and proactively assess and monitor pharmacy operations performance to achieve contractual targets on a daily basis. Frequently interface with counterparts across the organization to continuously identify and communicate opportunities for improvement with claims, pharmacy customer service and pharmacy core processes. Identify opportunities of improvements in business and operational areas; provide appropriate action plans, develop and implement pharmacy Operations performance analysis programs and metrics to improve operational efficiency. Continuously identify opportunities for improvement and trends via proactive assessment.

Responsibilities

• Assess and monitor performance of vendors for the pharmacy ops process to meet contractual and compliance requirements and align with EmblemHealth customer experience objectives and enterprise goals.
• Conduct reviews, transactional audits, and compliance and operational procedure reviews.
• Work with business partners to define, design and develop analytic and process solutions to improve operations performance and quality; identify, gauge and mitigate risks, through timely, accurate and consistent understanding of impact within operational area and across the organization and to customers.
• Analyze pharmacy ops performance and quality data to understand intended versus actual outcomes and evaluate performance and quality controls and tools to assess effectiveness in identifying errors in processes and systems.
• Communicate results to pharmacy Operations management via reports and presentations.
• Maintain meticulous audit and other assessment records to baseline historical performance and track and trend over time.
• Document special variation events that impact performance as well as corrective action taken to address issues.
• Support pharmacy Operations leadership as needed to conduct ad-hoc assessments and assignments.
• Perform related tasks as directed, assigned, or required.

Qualifications

• Bachelors degree.
• 3 5+ years of relevant, professional work experience (Required)
• 2+ years of auditing and assessment experience (Required)
• Additional experience/specialized training may be considered in lieu of degree requirement (Required)
• Ability to effectively utilize appropriate metrics to determine performance accuracy/outcomes (Required)
• Excellent collaboration skills and the ability to influence management decisions (Required)
• Strong auditing skills that can be applied across all types of business areas (Required)
• Proficient with MS Office Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc. (Required)
• Strong communication skills verbal, written, presentation, interpersonal with all types/levels of audiences (Required)

Additional Information

• Requisition ID: 100#######
• Hiring Range: $56,160-$99,360

Security Disclosure

If you receive a job offer from EmblemHealth, the email will be from HRTalentAcquisition with the subject: Offer of Employment for (job title) Please respond online. We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.

Pay Disclosure

At EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesnt account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individuals circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.

EEOC Statement

We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.

Sponsorship Statement

At EmblemHealth, we are committed to building a diverse and talented workforce. However, we are unable to consider applicants who require, or are likely to require, either before or after hire, visa sponsorship for work authorization in the United States, including but not limited to H-1B, F-1 (STEM OPT), TN, or any other non-immigrant status. Some extremely rare exceptions may apply based on critical business needs.

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