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AmeriHealth Caritas Manager, Technical Delivery & Oversight in Philadelphia, Pennsylvania

Manager, Technical Delivery & Oversight

Location: Philadelphia, PA

Telecommuter?: Yes

ID**: 19016

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com .

PerformRxis a Pharmacy Benefits Manager (PBM) dedicated to clinical culture, boutique service and holistic solutions. Our mission is to help customers, doctors and patients use effective medication therapy to improve health and wellness. For more than 15 years, our focus has been on providing optimal service through a clinical culture which seeks to provide members with high quality care while ensuring our partners receive favorable costs. That culture is reflected in our employees; more than 80 percent of our staff members are Pharmacists and Pharmacy Technicians, and in the services we provide.

PerformRxis headquartered in Philadelphia with offices on both coasts, leading to better pharmacy benefit management across the nation. Our dedication to innovation and to providing the most efficacious outcomes is the core of our clinical culture and is the heart of PerformRx. PerformRx is a subsidiary of the AmeriHealth Caritas Family of Companies.

Summary:

The Manager of Technical Delivery and Oversight will manage a team of technical delivery associates and have oversight of pharmacy claims processing, Healthcare IT, and AmeriHealth shared service partnerships.

Key Responsibilities:

  • Manage technical development processes specific to pharmacy data files, PerformRx portal, workflow management tool, AmeriHealth shared services relationship across multiple organizations

  • Oversee and enforce the PerformRx issue management process

  • Perform annual delegation oversight of claims processing technology vendors

  • Manage the daily activities of the team including staffing models, workflow management and audit support duties

  • Manage pharmacy claims processing application development, perform code reviews, work with pharmacy technology vendors, and advise teams of PerformRx standard requirements

  • Prepare written procedure, policies, reports, and correspondence ensuring continuous improvement of processes and delivery of results within the assigned team

  • Lead team in mitigating technical risks and applying appropriate contingency plans to ensure minimal impacts to customers

  • Coach, manage and develop employees by establishing clear goals, expectations, and strategies for employee performance

  • Develop and administer performance reviews with measurable goals

  • Provide opportunities for staff to maintain current industry knowledge

  • Provide opportunities for employees to build collaborative relationships with customers

  • Support the overall growth of PerformRx business by functioning as the Subject-Matter Expert (SME) in the RFP process, the new business implementation process and all auditing processes

  • Provide metrics and statistics to measure the operational effectiveness of the responsible line functions. Ensure all established processes have measurements in place, as well as a method for review and process improvement

  • Ensure all infrastructure controls comply with contract requirements, SOC 1 control objectives, URAC accreditation standards and any other prevailing standards for audit or accreditation

Education/Experience:

  • Bachelor’s degree is required

  • Project Management Certification is preferred

  • Minimum one (1) year of healthcare, Medicare, Medicaid and Pharmacy Benefit Management (PBM) experience required

  • Minimum three (3) years of experience of PBM (Pharmacy Benefit Management), Healthcare IT, Systems development, and people management preferred

  • Requires an advanced level of proficiency with Microsoft Office Applications (Word, Excel, Visio, PowerPoint, Project and Outlook)

EOE Minorities/Females/Protected Veterans/Disabled

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