Senior Pharmacy Analyst - Utilization Management - 20 hrs/wk

GENERAL SUMMARY:
The Senior Pharmacy Analyst supports the operations the Pharmacy Care Management Dept. by working on a variety of assigned projects, reports, audits, policies and procedures. This individual also serves as an expert resource on related pharmacy benefit management issues to both departmental co-workers and others within the organization and as a key contact to related external customers and vendors. May be dedicated to primarily supporting a specific product line such as Medicare or Commercial. 

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Collects and reports data to ensure compliance with internal policies and external regulatory requirements such as Medicare, NCQA, state and federal. Assists with audits.
• Develops, documents and maintains departmental policies, procedures, manuals and databases.
• Completes assigned tasks required for the efficient and cost-effective operation of the department. (E.g. coordinate mailings, formulary updates, rebate processing, excluded provider letters, transitions, member key changes, MAC pricing, support of coverage determination procedures, etc.)
• Researches and troubleshoots complex pharmacy benefit issues for members, pharmacies, physicians and management.
• Develops expertise in a particular product line such as Medicare or Commercial and serves as a resource for staff.
• Produces assigned departmental reports on schedule.
• Trains employees on pharmacy benefit procedures and policies.
• Other duties as assigned.