Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Director, Pharmacy Operations (IT/Systems)

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Director and Equivalent
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1915P Requisition #
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Responsible for developing and driving the strategy of Pharmacy IT projects, Platform Migrations, system updates and new pharmacy implementations.  Lead and mentor the team of Pharmacy System Specialists to produce high quality system outcomes by partnering with key stakeholders to develop concise and compliant business requirements for all IT/system related projects or platform migrations. Direct and oversee the daily operations and quality of production environments and enterprise pharmacy system processes and procedures.  Enhance system outcomes through strong critical thinking skills and knowledge of State and CMS regulations.  Ensure that systems team is monitoring processes for vendor data files, production issues, assessing risk and developing timely and compliant solutions to eliminate member abrasion.  Ensures policies and procedures are documented and communicated to team for training purposes.

Responsibilities:
  • Lead Pharmacy Systems Team responsible for IT Projects, Platform Migrations, and System Upgrades.
    • Lead a pharmacy systems team of 3 to develop accurate, detailed, compliant business requirements for each project assigned.  Achieve operational excellence by applying critical thinking to each requirement, each project.  
    • Pharmacy lead on all FACETs transformation projects including EmblemHealth and ConnectiCare lines of business.
    • Collaborate across the enterprise ensuring requirements are accurate and consistent with downstream and upstream functional processes.
    • Review and edit all business requirement documents ensuring accuracy and comprehensiveness.  Sign off on those requirement documents only when the business need is accurately described in those documents.
    • Review and edit test scenarios and test conditions for all development projects in which pharmacy owns a requirement or is impacted by a requirement.  
    • Review test output provided by IT, sign off only when functionality is proven to meet the business intent.  
    • Primary POC with ESI in all development projects.  Work with ESI technical team to align requirements, making certain that ESI is ready to implement in concert with EH/CCI projects.
    • End to end testing of functionality from EH/CCI to ESI.
    • Establish a practice of implementation monitoring to verify in production that new functionality is working as intended and that no other unintended downstream impacts have occurred.
  • Open tickets when errors are identified and work with IT team to correct those issues.
    • Provide technical support to pharmacy team and other internal partners on cross functional system initiatives.
    • Primary systems liaison with pharmacy vendors, IT partners and key business stakeholders.
  • Daily oversight of vendor files feeds, production gaps and daily pharmacy functional system operations.
  • Establish daily, weekly, monthly oversight of AGL, Eligibility, and Accumulator file processing.
  • Facilitate root cause identification of issues with IT vendor and PBM, define solution requirements/write BRD as needed and follow through on correction of issues consistent with overall project management approach.
  • Define the impact of each issue identified in terms of members, claims, finances (member and EH/CCI).
  • Escalate issues as required particularly when the issue results in a financial impact to EH/CCI.
  • Provide support to EH/CCI enrollment teams as needed.
  • Develop team members knowledge of IT systems, requirement definition and pharmacy operations.
  • Identify team member strengths and improvement opportunities.
  • As needed, identify supplemental courses that the team could engage in to further enhance their ability to write requirements, think critically, communicate effectively to both IT resources and business resources.
  • Identify best practices and train team members on those best practices.
Qualifications:
  • Bachelor’s Degree in Data Management, Business Administration, or related
  • Master’s in Business Administration or Advanced degree in related field preferred
  • 10+ years of experience (R) in systems analysis/business requirement definition
  • Pharmacy experience preferred, some healthcare business experience required
  • Experience in planning, coordinating and tracking multi-functional activities required 
  • Able to interface with a multidisciplinary team from IT developers, architects to business operations and Pharmacists
  • Strong leadership and exceptional organizational skills required
  • Ability to manage multiple priorities and execute projects with strict timelines required
  • Intellectually curious, a strong critical thinker required
  • Leads the team for independent decision making and problem resolution skills required
  • Able to streamline processes to match department and company goals required
  • Able to find automated reporting solutions that provide valuable insights for business consumption required
  • Commitment to compliance required
  • Excellent written and verbal communication skills required to work effectively with the matrix partners required
  • Knowledge of regulatory and accreditation requirements required
  • Knowledge of Health Insurance Portability and Accountability Act (HIPAA) required
  • Able to establish Strong QA process required

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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