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POSITION SUMMARY
WellSense has eight Accountable Care Organizations (ACOs) that provide coverage to over 500K Massachusetts residents under the MassHealth program. The pharmacy benefit is centrally administered by WellSense and aligns with the MassHealth Unified Pharmacy Product List (UPPL) and prior authorization (PA) guidelines. The Population Health Pharmacy Team works with the WellSense Pharmacy department, Boston Medical Center Pharmacy department, Population Health Core and Quality teams, system analytics teams, and the eight ACO partners to provide updates on changes to the MassHealth UPPL and PA guidelines, monitor pharmacy cost and utilization, and implement and integrate pharmacy quality initiatives. Under the direction of the Director of Population Health Pharmacy or other designee, the Pharmacy Program Manager is accountable for working with each of the ACOs to coordinate these activities.
Position: Program Manager
Department: Population Health Pharmacy
Schedule: Full Time
ESSENTIAL RESPONSIBILITIES / DUTIES
Analyzes data and information, develops strategies to improve operations and enhance service delivery; implements changes in conjunction with and advised from the management team.
In conjunction with the Population Health core and pharmacy teams, monitors ACO pharmacy cost, utilization, and quality metrics and identifies potential areas of opportunity.
Monitors program performance regularly, and plans and facilitates performance meetings with the Population Health core team, quality team and ACOs as appropriate and as contractually required.
Meets regularly with the appropriate leaders of each ACO group, and acts as the primary point of contact for any pharmacy-related ACO questions or concerns and triages to appropriate Wellsense or Population Health teams for resolution.
Implements new pharmacy requirements with the WellSense pharmacy department as outlined by MassHealth or the MA Executive Office of Health and Human Services (EOHHS).
Works with the Director of Population Health Pharmacy, the Senior Clinical Manager of Population Health Pharmacy, and other Population Health leadership to review available data and identify trends that may need to be addressed.
Performs other duties as needed
JOB REQUIREMENTS
EDUCATION
Bachelor's degree in Psychology, Social Work, Health Care Administration, Public Health, Nursing, or a a related field required. Master's degree preferred.
CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED
N/A
EXPERIENCE
5+ years of healthcare/managed care experience (specifically Provider Relations, UM, claims, quality, and/or project/program management)
KNOWLEDGE, SKILLS & ABILITIES (KSA):
Highly proficient with Microsoft Office products, including Word, Excel, and PowerPoint
Experience with client account management
Experience working with a pharmacy benefit manager (PBM)
Experience working with outpatient clinics
Experience with program implementation and performance management
Equal Opportunity Employer/Disabled/Veterans
Boston Medical Center’s policy is to ensure equal employment opportunities for all, without regard to race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic. We view the principle of equal employment opportunity as a vital element in the employment process and as a hallmark of good management.
BMC is an equal employment/affirmative action employer. If you need accommodation for any part of the application process because of a medical condition or disability, please send an e-mail to Talentacquisition@bmc.org or call 617-638-8582 to let us know the nature of your request.