Company Statement

Connecticare is a leading health plan in the state of Connecticut and a subsidiary of EmblemHealth, a health and wellness company that provides insurance plans, primary and specialty care, and wellness solutions.  WellSpark is a digital wellness company and national subsidiary of EmblemHealth that offers a full suite of products and solutions to reward people for healthy behaviors.

 

To protect the health and safety of our workforce, members, patients, and the communities we serve, the EmblemHealth family of companies require all new employees to be fully vaccinated for COVID-19. Exemption/reasonable accommodations may be granted because of 1) a qualifying medical condition or disability that makes getting the vaccine unsafe for the individual, or 2) objection on the basis of sincerely held religious beliefs and/or practices.
 

Director, Enterprise Pharmacy Analytics

📁
Director and Equivalent
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EmblemHealth
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  • Lead the enterprise in pharmacy trend analytics.
  • Direct rebate and PDE functions effectively across the enterprise.
  • Perform strategic and operational analytics, using data analytics tools efficiently to inform the business in support of strategic decision making, measuring the effectiveness of program implementations.
  • Evaluate contractual terms with PBM.

Responsibilities:

  • Manage monthly pharmacy trend and analytics processes.
  • Design and develop standard pharmacy reports to meet the needs of Enterprise Pharmacy and other leaders.
  • Identify key drivers of performance and areas of opportunity.
  • Work with counterparts in the pharmacy team and Express Scripts to address areas of concern.
  • Work to implement HCCI initiatives from trend analytics findings.
  • Track and monitor the results of implemented HCCI for internal validation.    
  • Support the enterprise in Pharmacy HCCI evaluation.
  • Assess PBM financial performance guarantees and track performance against the guarantees.
  • Validate PBM estimates of new pharmacy initiatives.    
  • Responsible for managing medical rebate processing and submission.
  • Ensure quality and accuracy of rebate data.
  • Work with internal + external partners to understand reporting needs and ensure the timely completion of the reports.
  • Responsible for maintaining databases for easy reporting solutions.
  • Build, submit and attest to accuracy of the annual and re-stated Direct and Indirect Remuneration (DIR) Submission.
  • Lead a cross functional team (pharmacy, finance, actuarial, vendors) to deliver the annual and re-stated DIR reports for two plan years concurrently.
  • Identify strategies to maximize DIR contribution to reduce premium costs.
  • Validate the accuracy of the DIR report including the contributions from vendor organizations by using audit tools and data analytics.
  • Interface with CMS on DIR submissions, attestation and any follow up required.    
  • Manage Medicare Prescription Data Event (PDE).
  • Achieve optimal reimbursement from CMS with a PDE acceptance rate of 99.95%+ for each of our CMS contracts.
  • Identify root cause of rejected PDEs and works cross functionally to resolve and eliminate recurrence of rejects.
  • Direct the ESI PDE team on prioritization of PDE reject resolution.
  • Oversee ESI performance to ensure conformance to CMS guidance.
  • Create a user friendly PDE dashboard to inform management of revenue secured through accurate, timely PDE processing.
  • Lead Data Analysts responsible for strategic and operational data analytics using both Pharmacy and Medical data.
  • Identify analytics solutions to business challenges.
  • Assess value of proposed and implemented strategies, identify improvement opportunities using data analytics.
  • Partner with business owners to achieve objectives and goals.
  • Provide data and analysis to enhance the value of the information provided.
  • Regular attendance is an essential function of the job.  
  • Perform other duties as assigned or required.    

Requirements:

  • Bachelor’s degree in Economics, Mathematics, Pharmacy, or similar major required: advanced degree preferred
  • 10+ years health insurance experience in a pharmacy role required
  • Advanced understanding of analytical principles and methodologies required
  • In-depth knowledge of the Health Insurance industry required
  • Experience in Medicare Advantage required
  • Excellent mathematical and analytical skills required
  • Strong communication skills (verbal, written, presentation, interpersonal) with all types/levels of audience required
  • Proficient with MS Office (Word, Excel, Powerpoint, Teams, Outlook) required
  • Advanced SAS knowledge required
  • Strong staff and process management experience required
  • Experience working closely with Actuarial and Finance staff required

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