Job DescriptionYour Role The Clinical Pharmacy Programs team within the Pharmacy Strategy & Operations department is a team of pharmacy professionals responsible for defining and executing strategies to address clinical quality, member experience, and affordability of prescription medications used by Blue Shield members. The Business Analyst, Consultant, Rx Quality Performance Management will report to the Senior Manager, Rx Member Experience & Quality Performance. In this role you will support the development, measurement, and continuous improvement of Pharmacy initiatives across the Commercial and Medicare lines of business. This role combines performance analytics, program management, member experience insights, and executive reporting to identify opportunities, measure outcomes, and drive member-centered improvements.
ResponsibilitiesYour Work In this role, you will:
- Provide highly complex analytical support through the analysis and interpretation of data in support of cross-functional business operations
- Lead the development of annual operating plans, capital budgets and forecasts, and build business cases for new business initiatives (cost/benefit analysis)
- Develop, prepare, and analyze reports with highly complex analysis and data for management review, and presents to various levels of management
- Define business requirements and provide analysis to increase operational efficiency
- Provide analytical support for multiple, highly complex cross-functional projects simultaneously, establish work plans and timelines, coordinates with internal and external resources
- Expand subject matter expertise on performance monitoring of drug quality and member experience measures to support program improvement and enterprise goals
- Establish and sustain strong, collaborative relationships and operating model with data and technology partners internally and externally to ensure robust management of drug quality performance
- Work independently with limited oversight to achieve goals and objectives
QualificationsYour Knowledge and Experience - Requires a bachelor's degree or equivalent experience
- Requires at least 7 years of prior relevant experience
- A minimum of 3 years' experience in managed care is preferred
- Requires strong analytic and problem-solving skills with intermediate to advanced knowledge of pharmacy data elements and related technical standards/concepts (e.g. claims, e-prescriptions, e-prior authorization, real time pharmacy benefits, etc.) Experience with HEDIS, CAHPS, NPS and Medicare Stars data preferred.
- Requires advanced proficiency in Microsoft applications including Word, Excel, Power Point, OneNote, SharePoint
- Requires excellent written, verbal, and interpersonal communication skills
- Requires experience working independently in a fast-paced environment
HybridThis role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.
Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.
Our Workplace Model We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:
- For most teams, this means coming into the office two days per week.
- Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
- For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.
Physical Requirements:Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
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