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WellCare - Pharmacy Management Careers

PBM & Network Oversight - Senior Manager Job

Full Job Title: Sr Manager, PBM & Network Oversight

Job Number: 1800041

Location: Tampa, FL

Date Posted: 1-5-2018

Department: Pharmacy

Reports to: Director of Pharmacy Benefits Relations

Location: 4110 George Road Tampa FL 33634

Responsible for providing leadership and oversight of multiple aggregation groups within pharmacy area, and is charged with delivering best-in-class strategies and expertise that result in department efficiencies and cost effective, optimal functionality. This role will plan and direct activities in the Pharmacy Network oversight functions of the Pharmacy Benefit Relations Department. Oversees the PBM's execution of pharmacy benefit administration, issue escalation, pharmacy claims review and testing, SPAP relationship management, as well as pharmacy network administration, contracting, network development, directories and operations. Assists in the development of pharmacy network strategy. Works in concert with the PBM, market leaders, and Pharmacy Department management to execute and oversee pharmacy benefit administration, pharmacy network strategy and performance.

Essential Functions:

  • Leads and develops an aggregate team of network oversight and pharmacy benefit associates including leadership and Pharmacy Benefit Relations Coordinators.
  • Responsible for the performance management processes for direct reports including coaching, counseling, providing feedback, career planning, goal setting, and performance assessment.
  • Responsible for oversight of pharmacy network and pharmacy benefit administration-related functions.
  • Performs data analysis and develops specific actions as needed.
  • Brings resources together in creative ways.
  • Ensures proper loading of state pharmacy network provider files at the PBM for accurate claim adjudication.
  • Supports delivery and validation of pharmacy network files used for provider directories.
  • Oversees the Medicare Plan Finder pricing files and associated Medicare STAR rating for accuracy.
  • Performs monitoring and oversight to ensure adherence to contractual obligations and manages regulatory reporting requirements.
  • Manages process improvement initiatives, seeking root cause and developing appropriate corrective action.
  • Establishes objectives, goals and performance measures for the function being managed.
  • Assists in developing short range plans for overall departmental activities.
  • May oversee the implementation of programs and strategies related to pharmacy benefits and pharmacy networks.
  • Acts in liaison capacity with the Pharmacy Benefit Manager and other internal and external business units.
  • Acts in support of Sr. Director, Pharmacy Benefit Relations in performing PBM oversight and managing SPAP Relationships.
  • Other duties as assigned.
Additional Responsibilities:Candidate Education:
  • Required A Bachelor's Degree in a related field
Candidate Experience:
  • Required 5 years of experience in Pharmacy benefit management with Part D knowledge
  • Required 5 years of management experience
  • Required 3 years of experience in Pharmacy network oversight
Candidate Skills:
  • Intermediate Ability to work in a fast paced environment with changing priorities
  • Intermediate Ability to communicate and make recommendations to upper management
  • Advanced Ability to drive multiple projects
  • Advanced Demonstrated interpersonal/verbal communication skills
  • Advanced Ability to lead/manage others in a matrixed environment
  • Intermediate Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions
  • Intermediate Demonstrated time management and priority setting skills
  • Advanced Ability to analyze information and covert related activities into a comprehensive work plan
  • Advanced Other Familiar with NCPDP claims transaction standards and pharmacy claims processing systems
Licenses and Certifications:
A license in one of the following is required:
Technical Skills:
  • Required Intermediate Microsoft Excel
  • Required Intermediate Microsoft Word
  • Required Intermediate Microsoft Outlook
  • Required Intermediate Microsoft PowerPoint
  • Required Intermediate Microsoft Project

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Last Updated On: 12/9/2015