JOB SUMMARY:
The Program Manager provides financial and operational support across Jefferson Health Enterprise ambulatory pharmacy business units, including but not limited to, financial reporting, business analytics and managing 340B program related operations. This position provides insight into monthly financial performance, identifying, implementing and presenting opportunities for improved financial performance as well as compliance with all applicable policies and regulations. This individual is also responsible for providing oversight of daily operations and analysis of the 340b program and all of its components, assuring adequate use of 340B acquired drugs throughout all Jefferson covered entities participating in the 340B program.
Essential Functions:
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Manages financial accounting functions for ambulatory pharmacy and 340B program daily operations, monthly financial reporting, and fiscal year operating budgets.
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Conducts deep-dive analysis to identify trends, variance drivers, and opportunities for improvement. Presents findings to stakeholders in a comprehensive manner.
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Implements strategies related to integration of pharmacy operational and financial data. Assists with business development initiatives by leveraging data analytics and financial modeling.
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Supports pharmacy revenue cycle team in reconciliation and reporting of open accounts receivable; works in collaboration to identify and resolve revenue cycle issues with vendors and payers.
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Assists with the development and maintenance of contract modeling process to ensure payments are consistent with Pharmacy Services Administrative Organization (PSAO) and direct payer agreements.
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Prepares analytics to support payer strategy in conjunction with Managed Care Contracting and operational leadership.
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Assists with the development, implementation, and maintenance of policies and procedures, work plans, and training programs according to the organization and federal requirements and guidelines related to 340B program.
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Monitors and assesses 340B guidance and/or regulatory changes, including, but not limited to, HRSA, OPA, Medicaid, and Medicare. Responsible for ensuring registration, recertification, terminations, and other changes are submitted in the OPAIS database.\
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Implements and oversees the completion of corrective action plans for internal and external audit findings upon approval by the 340B Steering Committee, as needed.
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Oversees access to 340B pricing, including implementing processes to comply with manufacturer policies and liaising between partners and drug manufacturers.
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Monitors hospital outpatient department activity and ensures continued performance with expectations. Analyzes volumes and trends compared to benchmarks, best practices, and strategic goals.
- Bachelor’s Degree in related field
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Data analysis, business intelligence, Financial planning and analysis
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Minimum of three (3) years broad pharmacy financial operations or financial analytics experience
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Minimum of three (3) years broad pharmacy financial operations experience.
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Minimum of one (1) year auditing experience
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Experience with pharmacy systems and in-depth knowledge of financial concepts and analytics requirements.
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340B University training required, Apexus Certification preferred.
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Experience with pharmacy billing preferred.
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Solid understanding of 340B auditing standards, techniques, and procedures.
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Experience with 340B Third Party Administrator (TPA) software preferred.
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Knowledge of the issues, trends, and challenges presented by participation in the 340B program.
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Experience with analyzing and reporting data in order to identify issues, trends, or exceptions to drive improvement of results and find solutions.