It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Reporting to the Senior Director of Pharmacy Services, the Pharmacy Program Manager is primarily responsible for pharmacy benefits configuration, including operational implementations in accordance with accreditation and regulatory requirements, as well as other processes and/or programs in support of regulatory requirements for all lines of business. The Pharmacy Program Manager also provides project management support across all pharmacy services initiatives that include both clinical and operational initiatives in support contractual obligations and fiscal goals. Additionally, documentation of policies, procedures, and programs shall be required.

Our Investment in You:

• Full-time remote work
• Competitive salaries
• Excellent benefits

Key Functions/Responsibilities:

• Responsible for accurate and timely implementations of pharmacy benefits and operations configurations
• Provides project management support for all pharmacy services initiatives across all lines of business
• Responsible for initiation, planning, tracking, documenting, execution, and monitoring and controlling of program implementations
• Proactively works with the project teams to identify and resolve issues, escalating when necessary to business owners and executive sponsors to work through obstacles and ensure project is executed successfully
• Interfaces with all areas affected by the project including end users and vendors
• Responsible for documentation of policies, procedures, and program designs in support of clinical, operational, and regulatory requirements
• Responsible for validation of benefits configurations
• Collaborates cross-functionally with both internal and external partners to support all projects and initiatives
• Participates on committees and/or lead cross-functional workgroups as necessary
• No direct supervision exercised but may be responsible for managing 10 - 20 FTEs on project teams
• Other duties as assigned

Qualifications:

• Must be experienced with project management processes, tools and templates, as well as project team roles and responsibilities
• Excellent written and oral communication skills
• Excellent interpersonal skills
• Strong organizational and time management skills, including ability to work independently and prioritize multiple projects and assignments
• Able to collaborate cross-functionally
• Ability to develop and support data dashboards
• Ability to analyze, compile, format, and present findings, data, queries, and reports to a variety of stakeholders
• Demonstrates ability to provide guidance and oversight
• Demonstrated strength in analysis, identification of problems and issue resolution
• Excellent skills in teamwork and team approaches to goal setting and attainment
• Must be results oriented

Education & Experience:

• Minimum of professional bachelor's degree in health care administration, public health or related field required
• Graduate study in a business, public health, or health policy field will be favorably considered
• Project management experience required
• Pharmacy industry experience highly preferred
• Experience with systems configurations and strong understanding of claims data
• Experience in a managed care setting, either from the provider, the payer, or the PBM side of the industry, is preferred
• Proficiency in standard computational office-suite applications, including project, word-processing and relational database manipulation is required

Competencies, Skills, and Attributes:

• Strong operational experience
• Familiar with regulatory requirements and accreditation standards
• Organized, with clear communication skills
• Ability to parse through problem statements and identify resolution

Working Conditions and Physical Effort:

• Regular and reliable attendance is an essential function of the position
• Occasional travel (<5%) may be required
• Ability to work in a fast paced environment

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.