Pharmacy Operations Specialist IV - Benefits - Aurora
Apply NowCompany: Kaiser Permanente
Location: Aurora, CO 80013
Description:
Description: Salary Range: $83.65/hour - $96.78/hour
Job Summary:
In addition to the responsibilities listed below, this position is responsible for using comprehensive knowledge of pharmacy benefits to partner with pharmacy and health care professionals to improve member service, affordability, and access; implementing benefits across necessary business lines (e.g., Commercial, Medicare, Self-funded, Exchanges, Medicaid) and determining benefit compliance with federal regulations and legislation; acting as a point person for solving moderately complex problems related to administrative activities including management of vendors, claim adjudication, audits, network management, drug pricing, and sales support including request for proposals; facilitating the facilitation of benefit training for health plan staff and external audiences with a focus on federal and regulatory compliance; using knowledge and experience to suggest improvements for the design, development, modification and implementation of new and current pharmacy benefits.
Essential Responsibilities:
Preferred Qualifications:
Primary Location: Colorado,Aurora,Central Support
Scheduled Weekly Hours: 40
Shift: Variable
Workdays: Mon, Tue, Wed, Thu, Fri, Sat, Sun
Working Hours Start: 12:01 AM
Working Hours End: 11:59 PM
Job Schedule: Full-time
Job Type: Standard
Worker Location: Flexible
Employee Status: Regular
Employee Group/Union Affiliation: NUE-CO-02|NUE|Non Union Employee
Job Level: Individual Contributor
Specialty: Pharmacy Operations
Department: Central Support Services - Rx Admin-Rx Benefit Management - 1608
Pay Range: $174000 - $201300 / year Kaiser Permanente strives to offer a market competitive total rewards package and is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not reflect the full value of our total rewards package. Actual base pay determined at offer will be based on labor market data and a candidate's years of relevant work experience, education, certifications, skills, and geographic location.
Travel: No
Flexible: Work location is on-site at a KP location, with the flexibility to work from home. Worker location must align with Kaiser Permanente's Authorized States policy. At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.
Colorado Residents: In any materials you submit, you may redact or remove age-identifying information such as age, date of birth, or dates of school attendance or graduation. You will not be penalized for redacting or removing this information.
Submit Interest
Job Summary:
In addition to the responsibilities listed below, this position is responsible for using comprehensive knowledge of pharmacy benefits to partner with pharmacy and health care professionals to improve member service, affordability, and access; implementing benefits across necessary business lines (e.g., Commercial, Medicare, Self-funded, Exchanges, Medicaid) and determining benefit compliance with federal regulations and legislation; acting as a point person for solving moderately complex problems related to administrative activities including management of vendors, claim adjudication, audits, network management, drug pricing, and sales support including request for proposals; facilitating the facilitation of benefit training for health plan staff and external audiences with a focus on federal and regulatory compliance; using knowledge and experience to suggest improvements for the design, development, modification and implementation of new and current pharmacy benefits.
Essential Responsibilities:
- Promotes learning in others by proactively providing and/or developing information, resources, advice, and expertise with coworkers and members; builds relationships with cross-functional/external stakeholders and customers. Listens to, seeks, and addresses performance feedback; proactively provides actionable feedback to others and to managers. Pursues self-development; creates and executes plans to capitalize on strengths and develop weaknesses; leads by influencing others through technical explanations and examples and provides options and recommendations. Adopts new responsibilities; adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; champions change and helps others adapt to new tasks and processes. Facilitates team collaboration to support a business outcome.
- Completes work assignments autonomously and supports business-specific projects by applying expertise in subject area and business knowledge to generate creative solutions; encourages team members to adapt to and follow all procedures and policies. Collaborates cross-functionally and/or externally to achieve effective business decisions; provides recommendations and solves complex problems; escalates high-priority issues or risks, as appropriate; monitors progress and results. Supports the development of work plans to meet business priorities and deadlines; identifies resources to accomplish priorities and deadlines. Identifies, speaks up, and capitalizes on improvement opportunities across teams; uses influence to guide others and engages stakeholders to achieve appropriate solutions.
- Applies strategies and concepts to independently support pharmacy and healthcare professionals by: independently leveraging systems and implementing programs and tools related to analytics and informatics to track prescription use data and support relevant patient-facing teams; collaborating with and co-leading meetings and relevant committees to support front-line operations; and exercising a patient focus throughout ones technical expertise and activities and identifying patient related issues, challenges, possible improvements and taking action to ensure the downstream patient impacts are being followed up on.
- Supports various functions within operations and may support operations in a specific area or set of pharmacies by: collaborating with interdisciplinary teams to implement pharmacotherapy safety practices and initiatives; implementing pharmacy operations initiatives and programs that directly support the day to day functioning of a specified set of pharmacies or locations and orchestrates across relevant groups on the rollout, staffing, education, etc. requirements; and maintaining various operational needs (e.g., workflow management, policy management, systems improvement, etc.), ensuring policy compliance, and identifying possible process or system improvements.
- Contributes to service, affordability, people, quality of care, and regulatory pharmacy goals by: leading efforts to create, design, and help implement strategic plan to support improvements to service, quality, people, affordability, and regulatory initiatives; evaluating data trends from and may being aiding in creation of tools and dashboards to enable implementation of new programs and initiatives; reviewing and mentoring others to conduct sweeps of new laws and rules from regulatory agencies and ensures application into operations (e.g., FAQs to markets); building and socializing new tools to ensure awareness and use; evaluating accuracy of inputs into and may be building accountability dashboard to ensure rules are followed; and aligns own operations goals to and assists junior colleagues to adhere to key affordability metrics.
- Serves as a subject matter expert for quality improvement processes and regulations within assigned area by: maintaining awareness of current internal policies and relevant external laws, regulations, and standards and serves as a source of expertise within certain defined areas; independently coordinating committees and projects that provide input and guidance on various improvement initiatives; developing, conducting, coordinating, and identifying quality improvements related to medication safety for assigned clinical area; researching and reporting related material; and anticipating issues, weighing practical considerations in addressing issues and seeking input from engagement manager/sponsor to resolve; leveraging knowledge of a wide array of drugs and their uses and how they impact clinical practices; guiding members, patients and/or healthcare providers to understand appropriate use and application of prescribed medication and providing drug information to relevant healthcare providers; applying advanced strategy to ensure achievement of member financial and therapeutic objectives; and analyzing, tracking, and reporting detailed member data to help assess plan outcomes.
- Minimum three (3) years of experience in Pharmacy Benefits.
- Doctorate of Pharmacy or equivalent degree (i.e., Bachelors of Pharmacy from a School of Pharmacy).
- Minimum one (1) year of experience in a leadership role with or without direct reports.
- Pharmacist License (Colorado) within 12 months of hire
- Pharmacist License (from any state) required at hire
- Knowledge, Skills, and Abilities (KSAs): Compliance Management; Benefits/Services
Preferred Qualifications:
- Three (3) years of experience working in a large matrixed organization.
- Two (2) years of experience in project management.
Primary Location: Colorado,Aurora,Central Support
Scheduled Weekly Hours: 40
Shift: Variable
Workdays: Mon, Tue, Wed, Thu, Fri, Sat, Sun
Working Hours Start: 12:01 AM
Working Hours End: 11:59 PM
Job Schedule: Full-time
Job Type: Standard
Worker Location: Flexible
Employee Status: Regular
Employee Group/Union Affiliation: NUE-CO-02|NUE|Non Union Employee
Job Level: Individual Contributor
Specialty: Pharmacy Operations
Department: Central Support Services - Rx Admin-Rx Benefit Management - 1608
Pay Range: $174000 - $201300 / year Kaiser Permanente strives to offer a market competitive total rewards package and is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not reflect the full value of our total rewards package. Actual base pay determined at offer will be based on labor market data and a candidate's years of relevant work experience, education, certifications, skills, and geographic location.
Travel: No
Flexible: Work location is on-site at a KP location, with the flexibility to work from home. Worker location must align with Kaiser Permanente's Authorized States policy. At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.
Colorado Residents: In any materials you submit, you may redact or remove age-identifying information such as age, date of birth, or dates of school attendance or graduation. You will not be penalized for redacting or removing this information.
Submit Interest