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   Current UPMC employees must apply in HR Direct

Manager, Business Operations Retail Pharmacy

  • Job ID: 971622458
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Community Provider Services
  • Department: Community Pharmacy Admin
  • Location: 1001 Oakdale Road, Oakdale PA 15071
  • Union Position: No
  • Salary Range: $29.80 to $50.31 / hour

Description

Manage the business operations for the Retail Pharmacy Network. Supervise employees engaged in providing centralized pharmacy business and financial activities. Manages the design, implementation support and maintenance of the retail pharmacy network software system. Perform in-depth analysis of the revenue cycle and business operations. Interprets and trends data, investigates variances and provides comprehensive reporting.

Responsibilities:

  • Perform in-depth statistical and qualitative analyses related to the revenue cycle and business operations, particularly, patient/member access data, and utilization. Ability to explain this analysis to a non-technical audience of both internal and external customers, including executive management.
  • Take initiative to investigate variances and derive conclusions and solutions from this data. Implement and monitor effectiveness of these solutions.
  • Perform complex financial/operational analysis from beginning to end with minimal supervision or direction from supervisor. Strategize new ways of trending/analyzing data in order to complete analysis
  • Develop access, utilization, and financial/operations reports for forecasting, trending, and results analysis. Monitor patient/member utilization data against regional and national benchmarks.
  • Meet deadlines and turnaround times set by department manager and director. These deadlines and turnaround times will, at times, require the employee to work until project is completed, meaning extended daily work hours, extended work weeks, or both.
  • Manage and oversee the third party reconciliation system for the Retail Pharmacy Network.
  • Oversee and have an expert knowledge of the retail software system that is used throughout UPMC retail pharmacies.
  • Assist with the recruitment, hiring and mentors staff and colleagues through feedback, positive discipline, and performance evaluations. Enforce progressive corrective action appropriately.
  • Oversees the analysis and documentation via the third party reconciliation management system of all reimbursement to ensure that pharmacy receives payment for all services rendered.
  • Manages the monitoring of accounts receivable to ensure that billing and posting are being done correctly.
  • Directs the analysis of end of day reports for each pharmacy to ensure that all billing was done correctly. Ensures adjustments are made as necessary to ensure reimbursement.
  • Monitor 340-B pricing to ensure claim accuracy within the retail software system and that the Retail Pharmacy Network is in compliance with Federal regulations.
  • Develop and monitor ongoing reports and tracking mechanisms for inventory and productivity.
  • Monitor and track specialty drug usage and reimbursement.
  • Define, develop and maintain internal third party plans. Manage the accounts receivable for the internal third party plans to ensure billing and posting are completed correctly.
  • Provide implementation and systems support for retail software system. Manage future enhancements and configuration changes.

Qualifications

  • B.A. degree in business, mathematics, statistics, health care, management or a related field.
  • Master's degree preferred.
  • 5 or more years' experience in financial and/or medical analysis or operations. 
  • Previous supervisory experience is preferred. 
  • Previous project management/leadership role experience required. 
  • Previous experience in pharmacy or medical operations is required.
  • Experience in health care insurance or health care industry preferred, but those with relevant experience in other industries will be considered. -
  • Superior computer skills with expert knowledge in Access, Excel, and other financial & statistical software packages.
  • Demonstrate a high degree of professionalism, enthusiasm and initiative on a daily basis.
  • Ability to work in a fast-paced environment a must.
  • Ability to manage multiple tasks and projects, and forge strong interpersonal relationships within the department, with other departments, and with external audiences.
  • Attention to detail is critical to the success of this position, with demonstrated competency in customer orientation and the ability to deal with ambiguity.
  • Excellent planning, communication, documentation, organizational, analytical, and problem solving abilities.
  • Advanced mathematical skills.
  • Ability to interpret and summarize results of various analyses in a timely and meaningful way.
  • Ability to effectively approach problem solving.
  • Ability to re-engineer processes to positively impact productivity in terms of timeliness and accuracy.
  • Possess technical knowledge and expertise in understanding patient access, physician template utilization, healthcare revenues, reimbursement and the correlation to the monthly financial statements. -
  • Ability to analyze financial & clinical results and to comprehend forecasting models.
  • Knowledge and expert understanding of most third party plans and payment reconciliation.
  • Well-informed and conversant with general business, economic, and clinical matters.

    Licensure, Certifications, and Clearances:
  • Act 34

  • UPMC is an Equal Opportunity Employer/Disability/Veteran

     

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