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Kaiser Permanente

Integrated healthcare provider and payer platform

Pharmacy Operations Specialist 3 - Benefits

PharmacyPosted on Nov 10
Full-timeReno, NV, USANo salary listedIn-person

About the Job

Requirements

  • At least two years of experience in Pharmacy Benefits.
  • A Doctorate of Pharmacy or equivalent degree, such as a Bachelor's of Pharmacy from a School of Pharmacy.
  • A pharmacist license from any state is required at hire.
  • A Nevada pharmacist license is required within 12 months of hire.

Responsibilities

  • Use working knowledge of pharmacy benefits to work with pharmacy and health care professionals to improve member service, affordability, and access.
  • Assist with implementing benefits across necessary business lines, including Commercial, Medicare, Self-funded, Exchanges, and Medicaid, and determine benefit compliance with federal regulations and legislation.
  • Resolve standard issues related to administrative activities, including vendor management, claim adjudication, audits, network management, drug pricing, and sales support, including requests for proposals.
  • Assist with facilitating benefit training for health plan staff and external audiences, with a focus on federal and regulatory compliance.
  • Suggest improvements to the design, development, modification, and implementation of new and current pharmacy benefits.
  • Provide coworkers and members with resources, information, advice, and expertise; seek and address performance feedback; mentor team members; pursue self-development; influence others through technical explanations and examples; adapt to change and help others adapt to new tasks and processes; and respond to others' needs in support of business outcomes.
  • Complete work assignments autonomously by applying current subject-area expertise to generate solutions, ensuring procedures and policies are followed, using data and resources to support projects or initiatives, collaborating cross-functionally to solve business problems, escalating issues or risks, communicating progress, monitoring priorities and deadlines, and implementing team improvements.
  • Support pharmacy and healthcare professionals by using analytics and informatics systems for patient-facing teams, collaborating with meetings and committees to support front-line operations, identifying patient-related issues and potential improvements, and following up on downstream patient impacts.
  • Support operations by collaborating with interdisciplinary teams on pharmacotherapy safety practices and initiatives; implementing pharmacy operations initiatives and programs for specified pharmacies or locations; coordinating rollout, staffing, and education requirements with relevant groups; and supporting workflow management, policy management, systems improvement, and policy compliance.
  • Contribute to pharmacy service, affordability, people, quality-of-care, and regulatory goals by coordinating the creation and implementation of improvement plans; evaluating data trends from tools and dashboards to support new programs; reviewing and influencing regulatory-law and rule sweeps and their application in operations; helping build and socialize tools; evaluating accountability-dashboard inputs for accuracy; and aligning operational goals to affordability metrics.
  • Develop subject-matter expertise in assigned-area quality improvement processes and regulations by maintaining awareness of internal policies and external laws, regulations, and standards; serving as a source of expertise in defined areas; coordinating committee sub-projects; developing, conducting, coordinating, and beginning to identify medication-safety quality improvements; researching and reporting relevant material; identifying issues and escalating them to the engagement manager or sponsor; applying knowledge of drugs and their clinical impact; guiding members, patients, and healthcare providers on appropriate use of prescribed medication and providing drug information to healthcare providers; applying strategy to achieve member financial and therapeutic objectives; and monitoring member data to assess plan outcomes.

Desired Qualifications

  • Two years of experience working in a large matrixed organization.
  • One year of experience in project management.

About the Company

Kaiser Permanente

Integrated healthcare provider and payer platform

Kaiser Permanente runs an integrated healthcare platform that lets members manage and pay medical, premium, and pharmacy bills online. It serves Medicare Advantage, Individual and Family, and non-employer plans, offering options to pay as a guest or set up payment plans. The platform works by presenting a centralized online portal where users can view bills, choose how to pay, and handle multiple types of charges in one place. Revenue comes from premiums and medical services fees, while the service aims to reduce administrative work for both providers and patients and encourage on-time payments. What sets Kaiser Permanente apart is its combination of healthcare services with a single billing experience across multiple plan types, focusing on a user-friendly, centralized payment process rather than handling billing through separate systems. Its goal is to provide a straightforward, reliable way for members to manage and pay their bills, improving convenience and payment timeliness.

Company size
10,001+
Company stage
Grant
Total funding
$7.5M
Headquarters
Oakland, CA
Founded
1945

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