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Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.

What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.

If you share our passion for changing healthcare so all people can live healthy, brighter lives – apply to join our team.

 

SCOPE OF ROLE

The Pharmacy Operations Sr. Analyst will focus on establishing and refining operational processes related to CMS and State requirements. This position will develop an oversight structure of PBM, departmental and key stakeholder activities. stakeholders. This oversight structure will include the establishment of KPI’s and program dashboards to measure performance.

ROLE RESPONSIBILITIES

Core responsibilities will involve project management, operational management, and materials management. The job description below is intended to point out other responsibilities within the role, but it is not limited to these items.

  • Build and manage dashboards for Prescription Drug Events (PDE’s), Financial Information Reports (FIR’s), Coordination of Benefits (COB) and NX Transactions.  This includes pulling data and tracking gaps at the PBM. 
  • Oversee PBM and Pharmacy Analyst work of PDE’s, FIR’s, NX Transactions, and Coordination of Benefits. 
  • Manage, and oversee Medicare Part D requirements and corresponding operational processes.   Including, but not limited to:  Prescription Drug Events (PDE’s), Financial Information Reports (FIR’s), Coordination of Benefits (COB) and NX Transactions
  • Develop and manage project plans for PBM, internal stakeholder, or external vendor initiatives to ensure an accurate, timely and highly coordinated implementation.
  • Define and document corporate oversight processes, policies, and procedures for all delegated pharmacy functions including those intended to identify risk and internal controls.
  • Establish PBM KPIs and Program dashboards to manage and measure outcomes related to performance guarantees.
  • Draft and maintain administrative pharmacy policies related to core job responsibilities.
  • Collaboratively work with both clinical and non-clinical areas within Bright.

SUPERVISORY RESPONSIBILITIES

  • This position does not have direct supervisory responsibilities, but will oversee Analyst work product.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

  • Bachelor’s in Science Degree required
  • Ten (10) years of professional experience in Pharmacy at a health plan or PBM.
  • Seven (7) years of project management/relationship management experience required, preferably in the pharmacy or healthcare industry preferred.
  • Five (5) years of management experience (employees and/or vendor services)
  • Five (5) years of experience in triaging and resolving inquiries associated to claims and benefits.
  • Five (5) years of experience working Medicare Part D

PROFESSIONAL COMPETENCIES

  • Previous experience managing Analysts and PBM’s.
  • Able to formalize and lead process oversight, data review, and resolutions needed when applicable.
  • 100% team player and ability to collaborate effectively with others to achieve common goals.
  • Able to multi-task and set priorities with strong organization and problem-solving skills supporting and enabling sound decision-making.
  • Advanced Excel and PowerPoint skills to create Executive Level schedules and presentations.
  • Strong analytic and critical thinking skills to resolve complex situational issues requiring design of processes which are lean, repeatable and comprehensive.
  • Self-starter that can develop and execute on a plan to address ambiguous situations or ones with limited direction.
  • Exceptional attention to detail.
  • Excellent customer service and communication skills.
  • Excellent written and verbal communication skills; ability to provide clear and concise information to senior leaders.
  • Comfortable following timeline driven workplans and managing multiple projects; thrive in collaborative environments.

LICENSURES AND CERTIFICATIONS

  • No licensures and/or certifications are required for this role.

WORK ENVIRONMENT

  • Remote
 

We’re Making Healthcare Right. Together.

We are realizing a completely different healthcare experience where payors, providers, doctors, and patients can all feel connected, aligned and unified on the same team. By eradicating the frictions of competing needs, we are making it possible to give everyone more of what they want and deserve. We do this by:
 
Focusing on Consumers
We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
 
Building on Alignment
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.
 
Powered by Technology
We employ our purpose built, integrated data platform to connect clinical, financial, and social data, to deliver exceptional outcomes.
 
          
 
As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of Bright Health, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
 

 

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