Highmark Health Pharmacy Analyst in Pittsburgh, Pennsylvania

Description

GENERAL OVERVIEW:

Work with Pharmacy Markets business owners, stakeholders and other management, as required, to achieve Pharmacy Markets growth objectives. Organize and coordinate Pharmacy Markets activities to focus on the successful delivery of desired results. Monitor and evaluate the progress, status and alignment of activities. Perform corrective action as needed to maintain the viability, relevance and timeliness of the work. Communicate regularly and effectively with customers regarding issues or concerns. Depending on the Pharmacy Markets business unit, may be responsible for one or more of the following:

  • Perform research on projects and manage and lead projects to successfully meet business objectives. May manage all size projects (small, medium, large, enterprise). Analyzes data to determine business problem, trends, or opportunities for process improvements.

  • Identify needs to develop new and innovative Pharmacy products, perform appropriate research/analyses, and evaluate feasibility of the administration and implementation of products.

  • Partner with business units to ensure compliance with governmental, contractual, and corporate guidelines, regulations, and policies and procedures. Continuously monitor regulatory changes, legislative efforts, industry trends, and/or contract changes.

  • Provide consultation and analytic support to assigned functional areas.

  • Collaborate with business owners/stakeholders to understand business needs, processes project specifications and business case development. Translate business needs into clearly defined and documented, high quality requirements, functional designs, and system supplemental specifications for new Pharmacy Markets applications and/or analyzes change requests/enhancements in existing Pharmacy Markets applications.

ESSENTIAL RESPONSIBILITIES:

  1. Implement product/program designs and ensure quality standards, financial performance, and regulations are met. Develop and establish standardized processes and effective measurement, evaluation and improvement methods. Implement interventions that result in continuous measurable improvements. Work collaboratively with business owners to identify areas where improvements are needed and to develop and monitor appropriate action plans to ensure a consistent focus on priority issues. General knowledge of key performance indicators (KPIs) and metrics.

  2. Analyze data processes, business processes, and interfaces to support multiple areas which will include program (and/or vendor) oversight, using appropriate measurement processes and potential audits. Gather and analyze information, designs and test solutions to problems and formulates plans. Make decisions that refine and improve known practices or develops new approaches.

  3. Work with multidisciplinary teams within Pharmacy Markets, other Highmark departments, and external vendors to ensure program effectiveness and general project management. Make independent contributions to projects as well as contributes and manages some small to medium projects, when applicable.

  4. Accountability for escalated or complex issue resolution.

  5. Develop business and pharmacy benefit solutions to satisfy mutually agreed upon goals and objectives; conduct problem solving resolution and decision making sessions for complex issues and projects; promote a culture of performance excellence and continuous quality improvement.

  6. Communicate effectively with all levels of the organization. Establish routine informational exchanges, based upon proposed product designs, prospective goal setting, strategic planning and implementation activities. Identify and articulate problems to management, steering committees and/or project sponsors.

  7. Research and develop competitive pharmacy benefit offerings and ensure proper positioning in the marketplace. Focus on achieving optimal member experience and continued viability of the pharmacy product portfolio.

  8. Other duties as assigned or requested.

QUALIFICATIONS:

Minimum Education and Experience

  • High school diploma or GED

  • 3-5 years of relevant, progressive experience in the area of specialization. Grandfathered experience requirements effective August 2016

  • Health care experience

  • Project management experience

Preferred Experience

  • 3-5 years business analysis experience

Knowledge, Skills and Abilities

  • Advanced experience with MS Office.

  • Experience in performing group/meeting presentations to technical/non-technical and customer audiences.

  • Strong critical thinking skills.

  • Ability to identify and assess patterns, trends, root causes, develop explanations and test solutions.

  • Ability to identify and assess problems and solutions, refer to applicable policies, identify options, and recommend appropriate courses of action.

  • Excellent verbal and written communication skills.

REQNUMBER: J118618

Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity