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Pharmacy Operations Oversight Specialist
2 months ago
Johns Hopkins Health Plans
is a leader in provider-sponsored health plans. If you are interested in improving how healthcare is delivered, and have a passion to be at the forefront of change, JHHP is the place to call home.
YOU belong here.
What awaits you:
Work-life balance -
This is a hybrid role requiring you to work
1 day per week
in the Hanover, MD office
Medical, Dental, and Vision Insurance.
403B Savings Plan w/employer contribution.
Paid Time off & Paid holidays.
Employee and Dependent Tuition assistance benefits.
Health and wellness programs and MORE
As the Pharmacy Operations Oversight Specialist,
you’ll:
Contributes to the development and implementation of oversight, monitoring, and audit plan related to JHHP pharmacy vendors
and other contracted entities
Develop corrective action plans for areas that are not meeting contractual and regulatory requirements
Create, maintain, and deliver oversight reports and program updates to pharmacy and compliance leadership teams
Design oversight programs to achieve desired results, target areas of risk, and mitigate compliance vulnerability for the health plan.
Support program development of Clinical Pharmacy Programs, manage databases and develop communications to members and providers.
Responsible for analyzing data specific to Medicaid, NCQA, and TRICARE regulatory submissions and providing critical feedback to the plan prior to submission
Monitor key performance indicators in clinical, operational, and vendor management areas to proactively inform leadership and departmental business owners of possible risks and issues
What you’ll bring:
3+ years of experience in a managed care, business, or healthcare environment, with demonstrated experience in data analysis, reporting, and project management.
Prior PBM experience strongly preferred.
Bachelor’s degree in Business Management, Healthcare Administration, or related discipline required.
Demonstrated proficiency with either SAS or SQL including ability to write queries based on business need is a plus
CPhT preferred
Who we are:
Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine. JHHP is a $3B business serving over 500,000 active members with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHP is a leader in provider-sponsored health plans and is poised for future growth.
Many organizations talk about transforming the future of healthcare, at Johns Hopkins Health Plans, we are setting the pace for change within the healthcare industry. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for our members and the communities we serve.
Johns Hopkins Health System and its affiliates are drug-free workplace employers.
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