Pharmacy Operations Analyst

Johns Hopkins - Hanover, MD

Full-time - Mid Level

Hanover, MD

10,001+ employees

Educational Services

About the position

As the Pharmacy Operations Oversight Specialist at Johns Hopkins Health Plans, you will play a crucial role in enhancing the oversight and monitoring of pharmacy vendors and contracted entities. This position involves the development and implementation of comprehensive oversight, monitoring, and audit plans to ensure compliance with contractual and regulatory requirements. You will be responsible for creating corrective action plans for areas that do not meet these standards, thereby contributing to the overall quality of healthcare delivery within the organization. In this role, you will also be tasked with creating, maintaining, and delivering oversight reports and program updates to pharmacy and compliance leadership teams. Your ability to design oversight programs will be essential in achieving desired results, targeting areas of risk, and mitigating compliance vulnerabilities for the health plan. Additionally, you will support the development of Clinical Pharmacy Programs, manage databases, and develop communications directed at members and providers. A significant part of your responsibilities will include analyzing data specific to Medicaid, NCQA, and TRICARE regulatory submissions. You will provide critical feedback to the plan prior to submission, ensuring that all data is accurate and compliant. Monitoring key performance indicators in clinical, operational, and vendor management areas will be vital to proactively inform leadership and departmental business owners of potential risks and issues, allowing for timely interventions and improvements.

Responsibilities

• Contribute to the development and implementation of oversight, monitoring, and audit plans related to pharmacy vendors and contracted entities.
• Develop corrective action plans for areas not meeting contractual and regulatory requirements.
• Create, maintain, and deliver oversight reports and program updates to pharmacy and compliance leadership teams.
• Design oversight programs to achieve desired results, target areas of risk, and mitigate compliance vulnerabilities.
• Support program development of Clinical Pharmacy Programs, manage databases, and develop communications to members and providers.
• Analyze data specific to Medicaid, NCQA, and TRICARE regulatory submissions and provide critical feedback prior to submission.
• Monitor key performance indicators in clinical, operational, and vendor management areas to inform leadership of possible risks and issues.

Requirements

• 3+ years of experience in a managed care, business, or healthcare environment with demonstrated experience in data analysis, reporting, and project management.
• Prior PBM experience strongly preferred.
• Bachelor's degree in Business Management, Healthcare Administration, or related discipline required.
• Demonstrated proficiency with either SAS or SQL, including the ability to write queries based on business needs is a plus.
• CPhT preferred.

Benefits

• Medical, Dental, and Vision Insurance.
• 403B Savings Plan with employer contribution.
• Paid Time off & Paid holidays.
• Employee and Dependent Tuition assistance benefits.
• Health and wellness programs.