AmeriHealth Caritas Jobs

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AmeriHealth Caritas Supervisor, Pharmacy Network in Philadelphia, Pennsylvania

Supervisor, Pharmacy Network

Location: Philadelphia, PA

Telecommuter?: No

ID**: 19143

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com .

Responsibilities:

  • Coordinate the efforts and deliverables of a team of associates in the Network Operations area specifically focused on Contracting, Credentialing, Auditing, Rates, Reimbursements and Reporting (Directories, Registries, Monthly Client Reports, Quarterly Client Reports, Yearly Client Reports, RFP Accessibility Reports, Drug Utilization Reports, etc.)

  • Serve as the 1st level escalation point-of-contact as well as the department representative for interdepartmental projects

  • Understand and able to perform all of the tasks in the Network Department related to contracting, credentialing, auditing and reporting

  • Run & prepare ad hoc and standard reports for Pharmacy Network, Contracting, Credentialing, and Pharmacy Audit

  • Gather and summarize data using appropriate software applications and disseminate to appropriate area

  • Manage projects plans and obtain status updates

  • Track accomplishments and delays in operational productivity improvements within Pharmacy Network Operations

  • Cooperate with others to achieve departmental goals, interdepartmental relations and public relations

  • Continual maintenance and assurance of Pharmacy Network Reports and internal databases

  • Monitor performance of the database management system, ensure database access, connectivity support, and restructure as necessary

  • Participate in network builds and test claims for the Pharmacy Network Department utilizing various claims processing platforms/reporting applications as necessary

Education/Experience:

  • High School Diploma or equivalent required; Bachelor’s degree preferred

  • Active/current national Pharmacy Technician certification (i.e., PTCB, NCCT, ExCPT) preferred or ability to obtain within 1 year of hire date

  • Minimum three (3) years of PBM and pharmacy experience required

  • Experience creating Microsoft Access databases required

  • Ability to read and understand pharmaceutical information

  • Working knowledge of pharmacy practices, procedures and precedents

  • Working knowledge of drug dosage forms, drug strength, generic & trade name equivalents

  • Understanding of URAC and CMS network requirements

  • Understanding of state level network requirements

  • Supervisory/management experience preferred

  • Strong communication (listening, verbal and written) skills

EOE Minorities/Females/Protected Veterans/Disabled

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