Manager, Medicare Pharmacy Operations

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🔥 12 hours ago

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Arkansas Blue Cross and Blue Shield

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1948

⚕️ Healthcare Insurance

Healthcare Insurance

Arkansas Blue Cross and Blue Shield is a health insurance provider licensed to offer health plans in all 75 counties of Arkansas. The company offers a wide range of insurance products including individual and family plans, Medicare and Medigap plans, dental and vision plans, as well as health plans for travelers and employer group plans. They provide members with personalized services such as health management through the Blueprint Portal, where users can manage their health plan, review claims, find healthcare providers, and estimate treatment costs. Arkansas Blue Cross and Blue Shield is an independent licensee of the Blue Cross and Blue Shield Association.

📋 Description

• Serves as a liaison with contracted vendors that provide administrative and clinical services for the pharmacy program. • Primary responsibility for the development and implementation of new benefit plans, products, and strategies designed to contain costs. • Represents Government Programs regarding issues such as implementing new programs, problem resolution and prevention, utilization management, policy management, and compliance oversight. • Responsible for various parts of the Medicare Pharmacy Program as defined by the Centers for Medicare and Medicaid Services (CMS).

🎯 Requirements

• Bachelor's degree in a medical field required. • Pharmacy Doctorate (PharmD) or Nurse Practitioner (NP) from an accredited college preferred • Minimum seven (7) years' experience within a pharmacy, clinical, and/or related health program administration function OR applicable Masters in related field with minimum five (5) years' experience. • Minimum five (5) years' experience dealing with external vendors and end users. (Example: Contract negotiating/management, coordinating and assuring vendor compliance etc.). • Minimum two (2) years' leadership experience (role, team and/or project management). • Experience in managed care, pharmacy management, utilization management, or other related functions preferred. • Knowledge of the Medicare Part D and Medicare Advantage benefits preferred.

🏖️ Benefits

• Tuition reimbursement. • Club Blue, a free, onsite gym to encourage exercise. • Green Leaf Grill and Green Leaf Grill Express, onsite restaurants in Little Rock that promote healthy eating. • Incentives for wellness education and exercise