Department: Pharmacy State & Benefit Relations
Reports to: VP Pharmacy Benefits Relations & PDP
Location: 4110 George Road, Tampa FL 33634
Oversees the implementation and continuous operation of the various cross functional operations and quality for the Medicare Prescription Drug Plan (PDP) market. Directs teams to implement a core operational processing system for the program and drive for continuous improvement in both operational and clinical outcomes. Develops on-going operational priorities, directs activities for the business function and manages resources to deliver to operational and financial goals.
- Oversees the operational processing area including Enrollment, Billing, Operations, Pharmacy and Data Capture functions to create, refine, and execute strategies for the (PDP) markets.
- Directs a cross-functional team including WellCare IT, Actuaries, Product, Operational departments and external vendors, to implement and drive process improvement for the core processing system for PDP operations.
- Implements a workflow routing process between the different operational groups for PDP and WellCare's business partners.
- Develops and manages the operational groups for Enrollment, Billing and other processing functions either through contracting appropriately to an outsourced vendor or building an in-house team.
- Develops the operating procedures and policies with the approval of the Chief Pharmacy Officer and VP, Pharmacy Benefits Relations and PDP. Implements audit programs and process improvement initiatives after implementation.
- Manages on-going operations for the PDP area including setting operational priorities, planning, providing resources, directing activities for the business function and managing resources to deliver to operational goals and budgets.
- Manages and develops direct reports who include other management or supervisory personnel and/or exempt individual contributors.
- Establishes on-going budget with the approval of the Chief Pharmacy Officer and VP, Pharmacy Benefits Relations and PDP and monitoring for adherence.
- Creates actionable strategies and develops recommendations to enhance PDP performance focused on achieving efficiencies, effectiveness and profitability.
- Performs other duties as assigned.
- Advises management in long-range planning for areas of process improvement and specialization
- Provides technical direction to functional managers, other directors and management in relation to the Core System and the Workflow solution for PDP
- Recommends changes in area(s) policy and procedure
- Required a Bachelor's Degree in a related field
- Preferred a Master's Degree in a related field
- Required 10 years of experience in Operations with hands-on experience in setting up or integrating new operations onto a new or existing processing system in the healthcare processing or managed care business
- Required 5 years of management experience
- Required provide proactive approach and support to emerging business activities established to remain competitive in the marketplace
- Required 5 years of experience in proven program/project management experience with the ability to drive cross-functional teams to achieve goals within set time lines
- Preferred 5 years of experience in Medicare MAPD and/or PDP operations
- Preferred 5 years of experience in Industry standard workflow tools and implementing such software in operational groups
- Preferred 5 years of experience in Process improvement in diverse healthcare areas covering different aspects of HMO business - health services management, customer support, claim processing, provider relations and support.
- Advanced demonstrated interpersonal/verbal communication skills
- Advanced demonstrated written communication skills
- Advanced ability to analyze and interpret financial data in order to coordinate the preparation of financial records
- Advanced ability to communicate and make recommendations to upper management
- Advanced ability to drive multiple projects
- Advanced ability to effectively present information and respond to questions from peers and management
- Advanced ability to influence internal and external constituents
- Advanced ability to lead/manage others
- Advanced demonstrated analytical skills
- Advanced ability to implement process improvements
- Advanced ability to represent the company with external constituents
- Advanced ability to work in a matrixed environment
- Advanced ability to work within tight timeframes and meet strict deadlines
- Advanced demonstrated organizational skills
- Advanced demonstrated project management skills
- Intermediate knowledge of healthcare delivery
- Required Advanced Microsoft Word
- Required Advanced Microsoft Excel
- Required Advanced Microsoft Access
- Required Advanced Microsoft Project
- Required Advanced Microsoft Outlook
- Required Advanced Microsoft PowerPoint
- Required Advanced Financial Management Systems (Generic)
- Required Advanced Healthcare Management Systems (Generic)