Manager, Pharmacy Benefits

Job Title: Manager, Pharmacy Benefits

Labor Grade: TBD

Department: Health Fund

Reports To: Director, Operations

FLSA Status: Exempt (Management)

About Us:

Building Services 32BJ Benefit Funds ("the Funds") is the umbrella organization responsible for administering Health, Pension, Retirement Savings, Training, and Legal Services benefits to over 100,000 SEIU 32BJ members. Our mission is to make significant contributions to the lives of our members by providing high quality benefits and services. Through our commitment, we embody five core values: Flexibility, Initiative, Respect, Sustainability, and Teamwork (FIRST). By following our core values, employees are open to different and new ways of doing things, take active steps to improve the organization, create an environment of trust and respect, approach their work with the intent of a positive outcome, and work collaboratively with colleagues.

For 2023 and beyond, 32BJ Benefit Funds will continue to drive innovation, equity, and technology insights to further help the lives of our hard-working members and their families. We use cutting edge technology such as: M365, Dynamics 365 CRM, Dynamics 365 F&O, Azure, AWS, SQL, Snowflake, QlikView, and more. Through this technology investment, we have gathered and analyzed thousands of data insights to influence health insurance legislation and propose new health policy. Our efforts have galvanized many leaders and the consensus is there is plenty more work to be done.

Please take a moment to watch our video to learn more about our culture and contributions to our members: youtu.be/hYNdMGLn19A

Summary:

The Manager of Pharmacy Benefits provides operational support to the Director of Operations in strategic vendor relationships, day-to-day oversight, and performance accountability of the Health Fund's pharmacy vendor(s), as well as managing vendor and Health Fund projects as necessary. Oversight of the vendors includes delivery of exceptional customer service, plan and regulatory compliance, monitoring the contracts for compliance, and measurement of the vendors' performance including analysis and recommendations based on reporting and performance guarantees.

Principal Duties and Responsibilities:

• Pharmacy Benefits Vendor Management

• Works with leadership to evaluate, modify and maintain vendor relationships
• Collaborates with vendors and internal teams to develop, prepare, and analyze production reports, including documenting submissions, reviewing trends, identifying outliers, comparing data with the Health Fund's Analytics team, and recommending reporting improvements and process enhancements as needed.
• Meets regularly with vendors to monitor progress on open items, review trends, and continue to develop relationships
• Works with vendor and internal team to resolve member issues timely, track performance guarantees, identify deficiencies, and create and track corrective actions plans as necessary
• Monitor pharmacy vendor(s) and ensure that key deliverables in oversight program are met and maintained by both vendor and by the Health Fund staff
• Supports the Director of Operations in organizing quarterly and annual meetings by preparing agendas, maintaining meeting minutes, tracking action plans, and following up on key deliverables. Additionally, assists in setting annual strategic goals

• Pharmacy Benefits and Incident Management

• Collaborates with the Director of Operations and the vendor to identify and address issues that arise during the daily management of the vendor relationship
• Reviews benefits and issues to recommend changes, enhancements and/or solutions and assists in the development of corrective action plans
• Identifies opportunities for benefit enhancements, in partnership with the vendor, that will improve the clinical outcomes of 32BJ members and reduce costs
• Assists the Director of Operations to design and implement benefit changes, including documentation and testing of changes.

• Communication

• Communicate directly with the vendors verbally and in writing to identify and resolve issues and plan design questions
• Partners with Communications to inform 32BJ Health Fund staff about health plan updates
• Communicates health plan modifications to vendor and ensures modifications have been coded in their respective systems. Also, assists in cross-departmental implementations.
• People Management
  • Direct supervision of staff member(s), responsible for identifying goals and managing and prioritizing workloads
  • Develop team member(s) through performance and development plans that focus on the strengths of the individual and areas for opportunity
  • Maintains quality service to vendors and internal partners by ensuring team meets performance requirements
• Project Management
  • Oversees all aspects of projects including working with other departments to set deadlines, assign responsibilities and monitor and summarize progress
  • Prepares reports for upper management regarding status of project
  • Identifies dependencies within the organization to ensure all aspects of each project are clearly documented and implemented appropriately
  • Liaises with vendors, as necessary, including monitoring of vendor deliverables, reviewing testing, and ensuring successful implementation of project
• Performs other relevant duties as assigned by senior management

Qualifications and Core Competencies: To perform the job satisfactorily, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required.

• Bachelor's degree in Biology, Pharmacy, Health Sciences or Business related field, or equivalent work experience in the health insurance industry.
• 3+ years' experience in pharmacy benefit management (PBM), pharmacy benefit administration (PBA), or specialty pharmacy management
• Background in pharmacy drug pricing/rebates, formulary design, prescription claims, mail-order pharmacy, cost control, or disease management for drug benefits
• Experience managing, developing, and inspiring staff
• Skilled in project management, adept at prioritizing tasks, meeting deadlines, and managing multiple projects with diverse teams
• Proficiency in data analysis, reporting, and data visualization using MS Office tools like PowerPoint and Excel
• Excellent communication skills, both oral and written, demonstrated by an ability to coordinate and communicate with internal and external stakeholders
• Proficiency in reading, writing, and understanding English is required; Spanish language skills are a plus