Transforming the future of healthcare isnt something we take lightly. It takes teams of the best and the brightest, working together to make an impact.
As one of the largest healthcare technology companies in the U.S., we are a catalyst to accelerate the journey toward improved lives and healthier communities.
Here at Change Healthcare, were using our influence to drive positive changes across the industry, and we want motivated and passionate people like you to help us continue to bring new and innovative ideas to life.
If youre ready to embrace your passion and do what you love with a company thats committed to supporting your future, then you belong at Change Healthcare.
Pursue purpose. Champion innovation. Earn trust. Be agile. Include all.
Empower Your Future. Make a Difference.
* As part of Change Healthcares Pharmacy Benefit Administration (PBA) business unit, the Pharmacy Manager will provide strategic leadership and direction for the delivery of enterprise-level support and service activities for PBAs Ohio Workers Compensation customer. The successful candidate will act as a liaison, on behalf of PBA, between the customer, technical support, product development, sales, and field service. A strong customer orientation, along with the ability to identify service model improvements, cost reductions, and value-add service opportunities are critical to being successful in the role.
Location: Columbus, Ohio
* Responsible for managing and maintaining the relationship with the client of the account(s) he/she is managing.
* Manages single PBM which may include Clinical Services:
* Clinical services may include clinical and administrative services related to PDL, SR, SMAC, RetroDUR, P&T Committee support, file transfers and maintenance, preparation of weekly drug file and post-P&T Committee meeting updates, maintenance for preferred drug list including budgetary and clinical reports
* PBM services include all clinical and administrative services related to online and real time claims adjudication, ProDUR/Concurrent DUR, SMAC, Rebate, file transfers and maintenance, review and maintenance for preferred drug list including budgetary and clinical reports, logistical support for State meetings
* Prepares, facilitates, and develops minutes of status meetings (frequency as required by contract and/or customer needs)
* Oversees management of help desk, PA, fiscal, program integrity and other staff (where applicable) to include, but not limited to onboarding/offboarding, recruiting, hiring, training, Kronos (Review time, PTO approval, submission of additional documentation for technician on-call time), and quarterly OKR reviews
* Assists Help Desk when needed (including answering help desk calls, reviewing overrides that require pharmacist approval, taking payment related calls from pharmacies, and discuss policies and requirements with Prescribers)
* Assists with fiscal operations where applicable (provider enrollment paperwork, answering questions from pharmacies trying to enroll, help processing checks, and TPL processing)
* Oversees Managed Care Organization (MCO) where applicable, including, but not limited to file transfer, claim adjudication, PDL files, etc.
* Enforces business rules and policies
* Works with PBA medical/clinical/data staff to analyze and forecast drug trends, summarizing data and preparing reports
* Develops a working knowledge of federal and state specific Pharmacy Policy and regulations, PDL/POS rules and suggesting enhancements and/or changes
* Attends meetings, legislative hearings, and makes presentations upon request of client
* Participates in Disaster Recovery plan preparation, updates, tests and real Disaster Recovery operations
* Participates in system enhancements, change requests, defect corrections and other Development/SRE needs as subject matter expert, provide UAT, facilitate customer sign off
* Oversees operations of any contractual duties including SLAs and deliverables
* Responsible for monitoring and adhering to contract SLAs for each account they are managing
* Provides audit support
* Responsible for report QA and submission Weekly, Monthly, Quarterly, Annual and ad hoc reports that need to be QA/QCd prior to delivery and then delivered to State
* Checks Monthly State Bankruptcy reviews where applicable (review for labelers and pharmacy providers
* Acts as CHC liaison for all aspects of Change Healthcare facilities management, approval on all supply orders, invoicing, general account questions, calling command center when issues arise, etc.
* Provides On-Call After Hours support;
* Supports the Business Development Team as a subject matter expert when needed to develop/review content for proposals as well as support product demonstration
5-7+ years in a retail pharmacy or a pharmacy benefit management setting
* Minimum B.S in Pharmacy required; Pharm.D. preferred.
* Must hold a clean and active pharmacy license in the State of Ohio.
Strong experience with pharmacy claims processing
Experience managing a team (hiring, performance management, training, etc.)
Proficient in analytical metrics relating to pharmacy claims
Proficient in Microsoft Office skills to include: Word, Excel, PowerPoint, Outlook
Experience presenting metrics via face-to-face or Web-Ex meetings.
* Previous Pharmacy Benefits Services/Managed Care employment or equivalent experience highly recommended
* Workers Compensation Experience preferred, but not required.
Physical: Travel as required
Join our team today where we are creating a better coordinated, increasingly collaborative, and more efficient healthcare system!
Equal Opportunity/Affirmative Action Commitment
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.
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