Pharmacy Team Lead - Pharmacy Services - Paramount - Full Time - Days - Full-time / Part-time

Paramount Health Care, a ProMedica Health Plan, offers insurance products across six Midwest states. This Ohio-based company, headquartered in Toledo, has more than 685 employees dedicated to serving their health plan members.  

Paramount offers Medicare Advantage and Marketplace Exchange health plans for individuals and families. Paramount maintains accreditation by the National Committee for Quality Assurance (NCQA) for their HMO and Medicare Advantage products.

In addition, Paramount has a full complement of insurance products for employers of any size, including medical, dental, vision and workers’ compensation, as well as vocational rehabilitation, life-care planning and wellness.

As a part of ProMedica, Paramount is driven by ProMedica’s mission to improve your health and well-being. ProMedica has been nationally recognized for its advocacy programs and efforts to address social determinants of health. Paramount strives to provide an exceptional experience to every member. For more information about Paramount, please visit our website at paramounthealthcare.com.

REPORTING RELATIONSHIPS/SUPERVISORY RESPONSIBILITIES

This position reports directly to the AVP, Pharmacy. The Pharmacy Compliance Coordinator and Pharmacy prior authorization team including Coordinators and Nurse Specialists report directly to this position.

POSITION SUMMARY

The Pharmacy Administrative Team Lead is responsible for supporting the Pharmacy Director in the effectuation of department goals, tasks, and initiatives, as well as providing leadership to coordinators and support staff. This team leader acts as an interdepartmental liaison for projects involving pharmacy: benefits and design, financial analysis, delegation oversight, regulatory compliance, and electronic file exchanges.

ACCOUNTABILITIES

*All duties listed below are essential unless noted otherwise*

• Responsible for coordinating complex projects within multiple business lines and programs, including the delegation of various responsibilities to employees and the oversight of their output.
• Supervise direct reports and communicate expectations, assignments, and responsibilities clearly and professionally. Conducts annual evaluations to guide potential improvements in each employee’s performance. Keeps AVP updated on team performance.
• Serve as the liaison between personnel and Pharmacists/AVP, managing needs, assignments, and communication.
• Assists AVP with hiring processes and is responsible for helping to train and mentor new hires. Direct reports may be entry-level or new to the industry and may require additional professional development.
• Leads the oversight of contractual duties for Pharmacy Benefit Management (PBM) and other prescription drug-related services provided by other First Tier, Downstream, and Related Entities (FDRs). Makes sure the team maintains records in support of audit requirements, troubleshoots issues appropriately, and organizes up-to-date internal documents, processes, and reports on delegated services.
• Assures team has gathered, analyzed, and prepared appropriate NCQA evidence and documentation, and may assist with upload during surveys.
• Supports all department initiatives in improving overall efficiency and quality. Assists Director in setting and implementing department strategic goals related to the ProMedica Journey of Excellence. Develops strategies to promote team member adherence to performance goals.
• Ensures that the team delivers prompt data analysis and data retrieval for key financial and quality initiatives such as the annual Medicaid Rate Setting Survey, PBM audits, the ProMedica Journey of Excellence, etc.
• Participates and makes recommendations for process improvements in work organization, communication, and efficiency with internal and external customers.
• Maintains updated policies and procedures to meet regulatory requirements. Work directly with Pharmacists and Director to assure compliance with mandates from CMS, ODI, and other regulatory bodies such as NCQA.
• Manages team staffing and PTO allowances.
• Represents the department in work groups and special assignments, as requested.
• Facilitate referral of appropriate members to Case Management.
• Other duties as assigned.

REQUIRED QUALIFICATIONS

Education: Bachelor’s Degree in business, pharmacy administration, healthcare administration, and/or related experience with pharmacy benefits administration.

Skills: Demonstrated leadership qualities in small teams; ability to exercise critical thinking and problem solving with minimal supervision; Strong written and verbal communication and customer service skills; Proficiency with Microsoft applications (Outlook, Word, Excel, and Access) and general business systems.

Years of Experience: Minimum 5 years of experience with managing pharmacy benefits or related work in managed care, with a strong background in analytics, and the ability to plan, coordinate and organize multiple priorities to meet deadlines.

License: N/A

Certification: N/A

PREFERRED QUALIFICATIONS

Education: MBA strongly preferred.

Skills: N/A

Years of Experience: N/A

License: N/A

Certification: N/A

WORKING CONDITIONS

Personal Protective Equipment: N/A

Physical Demands: N/A

ProMedica is a mission-based, not-for-profit integrated healthcare organizational headquartered in Toledo, Ohio.  For more information, please visit www.promedica.org/about-promedica

Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact employment@promedica.org

Equal Opportunity Employer/Drug-Free Workplace