Mgr, Pharmacy Perf-TT5041

1. Financial Performance Governance
   
   • Oversee evaluation of pricing guarantees, rebate performance, financial reconciliations, and pharmacy-related return on investment measures.
   • Monitor actual performance against contractual expectations and business cases.
   • Partner with Finance, Trend Management, and vendors to investigate significant variances and performance concerns.
   • Support governance discussions related to pharmacy financial performance and value realization.
2. Audit & Delegation Oversight
   
   • Maintain oversight of PBM audits, delegated service reviews, and vendor accountability activities.
   • Ensure audit findings, corrective action plans, and remediation activities are appropriately managed and monitored.
   • Track vendor compliance with delegated service requirements and contractual obligations.
   • Support preparation for internal, external, and regulatory audit activities impacting pharmacy vendors.
3. PBM & Vendor Performance Oversight
   
   • Lead oversight of PBM and pharmacy vendor performance across financial, operational, and contractual dimensions.
   • Monitor performance against service level agreements (SLAs), contractual guarantees, delegated service expectations, and other performance commitments.
   • Ensure vendor performance remains aligned with HMSA's strategic, clinical, and operational objectives.
   • Identify and escalate performance concerns requiring remediation, corrective action, or leadership engagement.
4. Team Leadership & Workforce Development
   
   • Lead and develop the Pharmacy Performance team.
   • Establish performance expectations and professional development opportunities.
   • Promote analytical rigor, accountability, and fact-based decision-making.
   • Foster strong relationships with internal stakeholders and external vendor partners
5. Performs all other miscellaneous responsibilities and duties as assigned or directed.

#LI-Hybrid

1. Bachelor's degree and five years of related work experience; or equivalent combination of education and related experience.
2. Experience in pharmacy operations, healthcare operations, or a Pharmacy Benefit Management (PBM) environment.
3. Three years of previous supervisory/management experience or six years of previous leadership experience.
4. Experience supporting pharmacy benefit implementation, operational readiness, and/or member-facing pharmacy programs.
5. Experience working with PBMs and external pharmacy vendors.
6. Familiarity with Medicare, Medicaid (Med-QUEST), Commercial, and specialty pharmacy operations.
7. Proficiency in development and execution of operational workflows.
8. Proficiency in problem solving and data collection, analysis, and interpretation.
9. Proficiency in development and execution of operational process flows
10. Intermediate working knowledge of Microsoft Office applications. Including but not limited to Word, Excel, and Outlook.
11. Leadership experience.
12. Knowledge of health care business, managed care operations, and contracting; locally and nationally