Pharmacy Operations Oversight Specialist

7 days ago

Hanover, United States Johns Hopkins HealthCare Full time

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 Business Analyst-Pharmacy (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 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
    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.

      Salary Range: Minimum 25.73 per hour - Maximum 42.48 per hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility.

      In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.

      JHM prioritizes the health and well-being of every employee. Come be healthy at Hopkins

      Diversity and Inclusion are Johns Hopkins Medicine Core Values. We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.

      Johns Hopkins Health System and its affiliates are drug-free workplace employers.

      Johns Hopkins Health System and its affiliates are an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.

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