Department: Pharmacy - State and Benefit Relations
Reports to: Sr. Manager Pharmacy Benefits Relations
Location: 4110 George Road Tampa FL 33634
Provides support and assistance to Director and Sr. Director of Pharmacy Benefit Relations in overseeing overall PBM activities. Acts as a liaison between WellCare and its external Pharmacy Benefits Managers (PBMs) with a focus on oversight of pharmacy claims processing and all aspects of the pharmacy benefit plans. Works daily with the PBMs and internal partners to coordinate initiatives that require PBM engagement in pharmacy processing, formulary setup, prescription editing, network audit, data files and benefit structure. Ensures the implementation of initiatives is achieved without setbacks through proper quality assessment measures and planning. Works with the Director and Sr. Director to oversee the project management of all PBM initiatives. Assists in the coordination of ancillary services provided by the PBM, regulatory reporting, and oversight of the PDE process. Oversees ancillary pharmacy including efforts of other areas of the Pharmacy Department.
- Provides support and assistance to Director and Sr. Director of Pharmacy Benefit Relations in overseeing overall PBM activities.
- Oversees regulatory reporting requirements that are provided by PBMs.
- Ensures appropriate setup of our all new plans and changes in benefit and copay structure.
- Ensures proper loading of membership for prescription benefits from Wellcare enrollment to PBMs.
- Ensures that all processes subject to regulatory requirements are being met. Examples of processes are EOB, transition letters, and price file downloads.
- Oversees data files that are exchanged through PBMs and WellCare.
- Assists in the overall project management functions impacting the Pharmacy department and PBMs.
- Executes ad hoc project or reporting requests as needed to support the Pharmacy Department.
- Understanding of pharmacy claims processing, pharmacy FWA, network audits, pharmacy benefits structure, formularies, and Medicare and Medicaid prescription plans and requirements.
- Required A Bachelor's Degree in a related field
- Required 5 years of experience in Pharmacy benefit management with Part D knowledge
- Required 2 years of management experience
- Advanced Demonstrated project management skills
- Intermediate Ability to communicate and make recommendations to upper management
- Intermediate Ability to analyze information and covert related activities into a comprehensive work plan
- Advanced Ability to drive multiple projects
- Intermediate Ability to effectively present information and respond to questions from peers and management
- Intermediate Ability to analyze and interpret financial data in order to coordinate the preparation of financial records
- Intermediate Ability to influence internal and external constituents
- Intermediate Demonstrated interpersonal/verbal communication skills
- Intermediate Ability to lead/manage others in a matrixed environment
- Intermediate Other Familiar with NCPDP claims transaction standards and pharmacy claims processing systems
Licenses and Certifications:
- Required Intermediate Microsoft Excel
- Required Intermediate Microsoft Word
- Required Intermediate Microsoft PowerPoint