Director, Benefit Design and Pharmacy Benefit Operations, SmartHealth
Ascension Health - St. Louis, MO

This job posting is no longer available on Ascension Health. Find similar jobs: Director jobs - Ascension Health jobs

This position is responsible for medical and prescription drug benefit designs and their delivery to SmartHealth clients and their employee base. This position provides support to members of the SmartHealth leadership team to assess new product ideas, including client and employee interest, regulatory issues, and financial implications. In addition, this position manages all aspects of the Pharmacy Benefit program customer service, including provision of support to the Chief Medical Officer for decisions about the drug formulary. Finally, this position partners with members of the Client Services team to support SmartHealth implementations from all perspectives – design, financial, administration, and employee communications.

Responsibilities:
  • Supports the assessment of new product ideas through engagement with SmartHealth clients, consideration of market trends and data, identification of the financial impact, and coordination with legal and administrative teams.
  • Directs SmartHealth vendors that provide product support, including pharmacy benefit administration, health account administration and, as needed, wellness program administration. Tasks include overview of program performance, confirmation of vendor adherence to performance standards, and the development and implementation of plan components and services to meet the needs of SmartHealth clients and their employees.
  • Assures that all components of SmartHealth meet local, regional, and national compliance standards along with any and all other regulatory requirements that may exist from time to time.
  • Partners with communications and legal resources to maintain compliance of required Plan Documents, Summary Plan Descriptions, and Summary of Material Modifications regarding plan changes. Coordinates the development, printing, and distribution of SPDs and SMMs for SmartHealth clients.
  • Leads the RFP process for SmartHealth vendors that provide product support.
  • Develops meaningful metrics for product performance and produces scorecards that inform decisions about future product changes to better meet the needs and objectives of SmartHealth clients.
  • Provides ongoing consulting to SmartHealth clients on plan performance and creates a forum for customers to provide feedback on all aspects of SmartHealth performance.
  • Maintains appropriate confidentiality in handling highly sensitive information, including plan design and individual pay/benefits information. Conducts all work in accordance with the Mission, Vision, and Values of Ascension Health Alliance.
  • Provides continued support, mentoring, and professional development to staff to allow professional growth and increasing support of health ministries.

Qualifications:
  • Education : Requires a minimum of a Bachelors Degree in Business Administration, Human Resources Management, or related field.
  • Experience : Ten years of progressive experience in health benefit plan design and administration. Demonstrated skill and experience in financial analysis and reporting along with the ability to handle difficult or sensitive plan administrative issues. Comprehensive knowledge of benefit principles, regulations, and laws affecting medical and prescription drug plans is required.
  • Special Training & Certification : Actuarial credentials, CEBS, SHRP or similar certifications are desired. Knowledge and skill in using Microsoft Office is required, including Windows XP, Excel, Word, and Access is essential.
  • Personal Skills, Aptitudes & Qualities : The position requires a mature individual who is conscientious, detail-oriented, and highly organized with the ability to schedule and complete a significant amount of work within time requirements; is able to work independently with minimal direction or as part of a team to accomplish his/her tasks; and possesses high project management skill. The incumbent must possess excellent written and verbal skills with the ability to make group presentations and prepare communications materials. Expressing opinions or information in a clear, concise and friendly manner on a level understandable to the audience to which it is intended is critical. The incumbent must be willing to travel and to work long and/or irregular work hours as necessary.
Ascension Health is an Equal Opportunity Employer M/F/D/V

Ascension Health - 18 months ago - save job - block
About this company
48 reviews
Ascension Health has ascended to the pinnacle of not-for-profit health care. As the largest Catholic hospital system in the US, and thus one...