Pharmacy Business Analyst
SummaCare - 1200 E Market St, Akron, OH
Full-Time / 40 Hours / Days
Hybrid
SummaCare is a Summa Health entity that offers health insurance in northern Ohio. As a regional, provider-owned health plan, SummaCare is based in Akron, Ohio, and provides Medicare Advantage, individual and family and commercial insurance plans. SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5-Star rating for 2024 by the Centers for Medicare and Medicaid Services (CMS). Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits.
Summary
Provides project and business analysis support for basic to moderately complex requests related to SummaCare and its Pharmacy Benefit Manager (“PBM”).
Formal Education Required
- Bachelor’s degree or equivalent combination of education and/or experience.
Experience & Training Required
- One (1) year of similar or relevant experience such as working in a health plan or in a Pharmacy Benefit Manager (PBM) role.
- Other Skills, Competencies and Qualifications:
- Demonstrate excellent verbal and written communication skills.
- Make sound decisions and recommendations based on consideration of facts, priorities, resources, and alternatives.
- Effectively utilize MS Word, Excel, and other software applications to perform job duties.
- Organize and manage time to accurately complete tasks within designated time frames in fast-paced environment.
- Maintain current knowledge of and comply with regulatory and company policies & procedures.
- Maintain confidentiality of member health information and business information.
- Flexible: ability to adjust work hours to meet business demands.
Essential Functions
- Provides support for pharmacy-related project management and business analysis requests including, but not limited to, data gathering and analysis, flowcharting of current process and procedures, creating project definition and scope, developing recommendations, implementing action plans, completing testing, and conducting quality assurance reviews.
- Designs, develops, and maintains pharmacy benefit reporting tools.
- Communicates, coordinates, and works with SummaCare and PBM Information Technology staff in resolving and completing Projects and System Requests that involve multiple departments.
- Designs, builds, tests and implements new pharmacy benefits with the Pharmacy Benefits Manager (PBM) as well as tasks related to year end.
- Communicates, coordinates and works with internal departments including Eligibility, Sales, Compliance Training, and Finance, to ensure successful implementation of new pharmacy benefits.
- Coordinates, tracks and monitors financials related to pharmacy, including PBM Performance Guarantees and Rebates
- Monitors and coordinates Medicare Prescription Drug Event (PDE) activities for the health plan.
- Serves as Subject Matter Expert (SME) for the Pharmacy Management Team.
- Performs all job functions with integrity. Provides timely internal and external customer service in cooperative, professional, and respectful manner.
Level Of Physical Demands
- Sit and/or stand for prolonged periods of time.
- Lift up to 20 pounds.
- Manual dexterity to operate computer, phone, and standard office machines.
Equal Opportunity Employer/Veterans/Disabled
$33.66/hr - $50.49/hr
The salary range on this job posting/advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location are considered when determining the starting rate of pay. We believe in the importance of pay equity and consider internal equity of our current team members when determining offers. Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical.
