Pharmacy Financial Lead job in San Juan

San Juan Medical Card System, Inc.

Job Ref:	req3516
Employer:	Medical Card System, Inc.
Sector:	Health Insurance
Qualifications:	Unclassified
Software:	Tableau Excel SQL
Job Type:	Full Time
Salary and Benefits:	Competitive
Remote:	No
Location
Country:	United States
City:	San Juan
Post Code:	Not specified
Map:	(Show on map)
Description
Pharmacy Financial Lead Regular Exempt GENERAL DESCRIPTION Responsible for the Pharmacy Department Financial Activities such as Budget and Savings Initiatives. Develops, analyzes, and evaluates pharmacy savings initiatives and monitors the quarterly savings of these. Ensure accurate budget development and performance oversight. Translates needs and requirements of the operational and clinical area into reports modeling and integrating data from various sources. These responsibilities are tied to MCS and Global Health Financial Activities. ESSENTIAL FUNCTIONS • Lead and support EMMs initiatives activities in accordance with established schedules, milestones, resources, issues, and scope. Ensure that all projects are well scoped, well documented, and completed on time. Also, regularly informs executive sponsors and key stakeholders of the project's status. • Will meet directly with providers and/or participate in committees or work sessions to collect the requirements and needs of the EMM initiatives, this with the purpose of serving as a technical expert at the pharmacy area to develop and agree on the final report solution. that supports effective EMM's Initiatives savings calculation. • Collaborate with key stakeholders to identify projects gaps, barriers, and opportunities for improvement. • Develop and implement issues resolution and enhancements that are align with the pharmacy department financial objectives.Resolve issues before health plan performance results are impacted. • Participates in high-impact corporate projects for the company in which it must collect requirements, define, and create the solution that facilitates the monitoring of performance metrics. This solution should facilitate the performance of the necessary analyses to be presented to the clinical or operational area. • Understand and perform savings projections analysis and monitoring. • Document for each EMM Initiative a sum the summary of the savings projections calculation logic and supporting report. • Works with Finance, Actuarial, and other related departments in the preparation of the departmental budget. Assists finance by providing analysis of drug utilization and cost trends. It is the link between the PBM and Finance in the request of the reports used so that the Budget can be calculated. • Identifies patterns and/or trends of financial impact related to drug costs and presents them in a monthly meeting with pharmacists so that they can identify which drugs can affect the positive or negative variances of the budget. • Interprets and analyzes utilization reports that reflect financial impact trends, to support senior management in decision making; makes recommendations in this regard. • Ensures that a gap analysis to identify drivers for budget variances is performed and perform analysis that supports the driver's identification. Develop with the clinical area initiatives to close variances and monitor effectiveness of the initiatives. • Perform PBM Financial Guarantees oversight. Ensures that a gap analysis to identify drivers for identified variances is performed. Perform analysis that supports the driver's identification. Develop with the PBM initiatives to close variances and monitor effectiveness of the initiatives. • Perform MAC Pricing Process Oversight. Ensures that a gap analysis to identify drivers for identified variances is performed. Perform analysis that supports the driver's identification. Develop with the PBM initiatives to close variances and monitor effectiveness of the initiatives. • Conduct thorough review and validation of invoices received from vendors and ensure accuracy and adherence to contractual agreements and pricing structures. Identify and resolve any discrepancies or billing errors in a timely manner, collaborating with relevant stakeholders to rectify issues and prevent future occurrences. • Develops and/or creates reports integrating several databases. Analyze, identify, and present patterns and/or trends of financial impact to make projections that serve senior management in decision making. • Collaborate with key stakeholders to identify gaps, barriers, and opportunities for improvement, also develop and implement enhancements that are align with the pharmacy's programs objectives. • Identify and reports significant issues and underlying problems, accompanied by proposed solutions, in a timely manner to leadership. Also, resolving issues before health plan performance results are impacted. • Prepare and deliver presentation materials for management level, internal or external users. • Perform Financial Analysis, tracking and trends. • Collaborates with cross-functional teams to ensure compliance and quality requirements are met as per local and federal laws and regulations and other agencies. • Participates and collaborates with internal and external audits, in the division's processes automation, corporate and departmental initiatives, and other similar tasks. • Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices. • May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document. MINIMUM QUALIFICATIONS Education and experience: Bachelor's Degree in Business Administration, Finance, Pharmacy, Statistics, Biostatistics, Quantitative Methods, or related areas. At least five (5) years of previous experience performing similar responsibilities analyzing, managing data, and making presentations in the Healthcare industry. "Proven experience may be replaced by previously established requirements." Certifications / Licenses: N/A Other: Intermediate to advance knowledge in at least four database tools: Tableau, ACCESS, Brio, Power Pivot, Excel, SQL, and Power BI. Knowledge in analysis and management of tables and relationships in databases. Knowledge of Medicare Star Program requirements is preferred. Languages: Spanish - Advanced (writing, conversational, comprehension, and reading) English - Advanced (writing, conversational, comprehension, and reading) "Somos un patrono con igualdad de oportunidad en el empleo y tomamos Acción Afirmativa para reclutar a Mujeres, Minorías, Veteranos Protegidos y Personas con Impedimento"

ref: (req3516) 14 days ago

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