Ready to help us transform healthcare? Bring your true colors to blue.
The Role
The Pharmacy Operations Manager plays a critical role in the management of the Pharmacy prior authorization process which encompasses staffing, workflow management, quality and production and reporting to ensure regulatory compliance and service excellence. Reporting to the Director, Pharmacy Operations and in partnership with the Clinical Manger, this role will have responsibility for the call center associates and supervisors to ensure strong performance to metrics, support corporate First Call Resolution goals and foster a culture of development and performance excellence.
This role is eligible for the Flex persona. This position can be fully remote, with expectations to work in our Hingham, MA office 2x per month.
Major Responsibilities:
Lead and motivate Pharmacy Operations team associates to ensure service excellence; provide ongoing coaching, performance management, training and development
Develop and support team goals and objectives, work with associates to establish measurable individual performance goals and monitor progress toward achievement of goals on regular basis to ensure high standards are met, recognize success and coach to improve performance issues.
Create processes to effectively improve production and operating efficiencies while maximizing member/provider satisfaction.
Provide regular data and reports to assess team and individual metrics and in compliance with required reporting for NCQA, CMS and other stakeholders as needed.
Evaluate, plan and mange staffing needs on ongoing basis according to Pharmacy program initiatives and benefit changes including forecasting temporary staffing needs.
Lead the recruiting and training activities for full time and temporary staff and manage ongoing relationship with temporary staffing agencies.
Facilitate team meetings for all lines of business.
Manage staff of supervisors to provide day to day oversight of operations, reporting, workflow development and floor support.
Contribute to a culture of service excellence by anticipating the needs of our providers and members and ensure the Pharmacy Operations team delivers a level of service consistent with the BCBSMA First Call Resolution goals.
Support new clinical program implementation through partnership with Clinical Operations Manager.
Represent the interest of our members and providers through active participation within various workgroups to ensure the success of the Pharmacy initiatives Responsible to maintain all regulatory requirements including, but not limited to, NCQA, MCRA, CMS for turnaround times, documentation, notifications and audit activities.
Develop, implement and maintain all departmental Policy and Procedures and represent Pharmacy at monthly P&P meetings.
Responsible for business oversight of after hours delegation program with PBM to ensure compliance with all NCQA requirements and to monitor service levels and quality of PBM staff.
Research and manage to resolution escalated service issues with PBM mail order and customer service areas received from internal and external customers.
Lead testing, training and implementation of new systems and periodic enhancements to existing platforms.
Special projects as assigned
Qualifications (Knowledge, Skills, and Abilities):
Ability to manage in call center environment: forecast and manage staffing needs, develop and monitor team and individual metrics, create and utilize reports to measure cost, quality and productivity, identify/ implement workflows and process improvements
Excellent organizational, problem solving and communication skills
Strong planning, prioritizing and execution skills as well as the ability to work independently to meet tight deadlines
Demonstrated leadership skills and experience; ability to work cross-functionally, build consensus, coach and develop staff and build morale
Knowledge BCBSMA Pharmacy systems preferred
Experience with and a working knowledge of MS Office suite of application
Education/Relevant Experience:
Bachelor's Degree or equivalent working experience
3-5 years supervisory experience; call center management experience strongly preferred
Strong written/verbal communication skills including presentation skills
Minimum Education Requirements:
High school degree or equivalent required unless otherwise noted above
LocationHinghamTime TypeFull time
Salary Range: $75,060.00 - $91,740.00
The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.
This job is also eligible for variable pay.
We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.
Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
WHY Blue Cross Blue Shield of MA?
We understand that the confidence gap (https://www.theatlantic.com/magazine/archive/2014/05/the-confidence-gap/359815/) and imposter syndrome (https://www.braintreepayments.com/blog/overcoming-imposter-syndrome/) can prevent amazing candidates coming our way, so please don't hesitate to apply. We'd love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It's in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.
As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting our Company Culture (https://careers.bluecrossma.org/us/en/culturepage) page. If this sounds like something you'd like to be a part of, we'd love to hear from you. You can also join our Talent Community (https://careers.bluecrossma.org/us/en/jointalentcommunity?applyType=JTC) to stay "in the know" on all things Blue.
At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work (https://careers.bluecrossma.org/us/en/how-we-work) " Page.
Voted as the highest in member satisfaction among Massachusetts commercial health plans by JD Power , Blue Cross Blue Shield of Massachusetts is a community-focused, tax-paying, not-for-profit health plan headquartered in Boston. We have been a market leader for over 75 years, and are consistently ranked among the nation's best health plans. Our daily efforts are dedicated to effectively serving our 2.8 million members, and consistently offering security, stability, and peace of mind to both our members and associates.
Our Commitment to You
We are committed to investing in your development and providing the necessary resources to enable your success. We are dedicated to creating a refreshing and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path. We take pride in our diverse, community-centric, wellness-focused culture and believe every member of our team deserves to enjoy a positive work-life balance.
Blue Cross Blue Shield of Massachusetts is an Equal Employment Employer - veterans/disability. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or expression, or any other characteristics protected by law.
Blue Cross Blue Shield of Massachusetts will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with Blue Cross Blue Shield of Massachusetts's legal duty to furnish information.
