Manager Pharmacy Member Outreach

Position Description

Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more. 

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”

This role is responsible for day-to-day coordination, leadership, and strategy of the Pharmacy Member Outreach arm of the Medicare Pharmacy team. This role is also responsible for the formal oversight of the PBM Care Team performance. Prioritize daily, weekly, monthly focus of PBM Care Teams and Member Outreach team. Oversight of capacity and prioritization for PBM Care Teams vs. internal team division of tasks and coordination with matrix leaders to maximize outcomes. Clear oversight and formal assessment of PBM Care Team performance and continuation of same level of support. This leader will have a customer service, process improvement, and data driven skillset and be able to interface effectively with leaders of Capital Blue Cross. The Manager reviews and updates departmental policies and procedures, monitors the performance of the pharmacy benefit manager Care Teams, manages assigned projects, establishes and monitors key performance indicators and quality controls, and assists in strategic work planning, strategic thinking, and productivity.

Responsibilities and Qualifications

• Work with Stars Program leaders to develop and execute Stars-focused roadmap that defines the path to operationalize specific actions which are repeatable, measurable, and cost-effective. Support the creation, drive implementation, and monitoring process of the Stars Program strategy, objectives, tactics, and initiatives to drive a year over year 4+ overall Star Ratings and meeting Program goals. Drive innovative initiatives that address low-performing measures. Develop standard reports, tracking tools, metrics to monitor vendor performance, Stars/Quality measures, tactics, and initiatives. Coordinate with existing vendors, and/or implement new vendors, in order to drive desired outcomes in quality-based metrics. Gather Stars reporting data, analyze CMS changes, collaborate with Stars leads to set strategic direction. Lead and/or actively participate in meetings, workgroups, committees, etc. as Stars team expert. Collaborate in the creation, implementation and monitoring process of policies and procedures, standard operating procedures, performance guarantees and workflows to drive effectiveness, efficiency and scalability. Direct supervision and management of Pharmacy Member Outreach staff, ensuring proper application of policies and procedures and quality controls. Interface and oversee the pharmacy benefits manager (PBM) and any other related pharmacy vendors with respect to applicable Pharmacy Stars measures. Oversee pharmacy vendor Stars process(es) for effectiveness. Oversee cross-functional exchanges of information and procedural changes that impact Stars outcomes. Serve as department/business lead between pharmacy vendor(s) and internal departments to coordinate Stars needs and problem resolution. Assists in evaluating, developing, and implementing department administrative policies and procedures. Maintain appropriate staffing schedules to assure adequate coverage and workload distribution. Manage personnel issues, including hiring, training, staff performance reviews, and facilitating staff development activities. Monitor PBM performance standards and other contractual issues to assure compliance. Contributes creative solutions to improve operational efficiency and effectiveness of pharmacy team. Evaluate the effectiveness of existing metrics, developing new metrics as necessary, to better assess the performance of organization in achieving Pharmacy quality and satisfaction targets. Perform other duties as assigned.

Skills:

• Excellent verbal communication and interpersonal skills. Able to convey complex and/or technical information in a manner that others can understand. Proven success on building and maintaining positive relationships. Exemplary of a highly collaborative team approach. Ability to influence and persuade people to collaborate and execute toward a common goal.