Program Manager, Pharmacy Services - Workers Compensation Claims - Berkley

Company Details:

 

Berkley Medical Management Solutions (BMMS) provides a different kind of managed-care service for W.R. Berkley Corporation. We believe focusing on an injured worker’s successful and speedy return to work is good for people and good for Berkley’s insurance operating units. BMMS was first started in 2014 by reimagining the relationship between medical need and technology as a way to deliver the best outcome for injured workers and Berkley’s operating units. Our goal was clear: combine solid clinical practices, proven return-to-work strategies and robust software into one system for seamless management of workers’ compensation cases.

 

To get it right, we started with a flexible technology platform that allowed for impressive customization without sacrificing the ability for expansion and continued innovation. We deploy integrated systems to give W.R. Berkley Companies recommendations and professional services for managing each individual case in an efficient and appropriate manner. The power of our technology takes medical bill-review services and clinical advisory services to a new level. Our unique marriage of technology, software platforms, data analytics and professional services ensures we provide Berkley’s operating units with reliable results, and reduced time and expenses associated with case management.

Responsibilities:

As the Manager, Pharmacy Services you will be the primary liaison for all components of the pharmacy program, collaborating with our pharmacy benefit manager, our product management team and our clients.  You will provide guidance, analytics, insight and leadership to help promote injured worker safety, improve pharmacy savings and increase efficiencies of the pharmacy program.

 

You will support program-related short term and long term operational, product and/or technical solutions and strategies through guiding development of enhancements to improve end to end clinical process and systems decision making. We’ll also look to you, in collaboration with internal partners and our pharmacy benefit manager, to design and implement pharmacy solutions or internal business functions by providing clinically relevant research and analysis of pharmacy and related clinical data.

 

• Liaison between external pharmacy partner and internal stakeholders and clinical management team
• Interact with adjusters and clinical teams to drive best-practice adoption across the organization to achieve the best outcomes
• Educate internal and external peers and colleagues on clinical and pharmacy concerns, issues or trends
• Data analysis and reporting to provide understanding and effectiveness of programs and claimant outcomes to internal and external stakeholders
• Develop and maintain a strategic roadmap for the pharmacy program, aligning with overall business objectives and market trends
• Lead integration efforts between our internal systems and the external partner's platforms to ensure seamless data flow and operational efficiency
• Development of pharmacy trend reporting for management in conjunction with our pharmacy benefit manager
• Assist in the development of and track key performance indicators (KPIs) for the pharmacy program, using data-driven insights to drive continuous improvement
• Work with the external partner to identify and implement continuous improvement initiatives, leveraging best practices from both organizations
• Champion user-centric design in all pharmacy program interfaces and processes, ensuring an optimal experience for internal and external users
• Create and maintain a structured collaboration framework with the external partner, including regular review meetings, joint planning sessions, and escalation procedures
• Anticipates customer needs and proactively develops solutions to meet them
• Establish and manage an innovation pipeline for the pharmacy program, including evaluation and implementation of new technologies and service models

Qualifications:

• 5+ years of leadership and program management or account management experience
• Strong influencer with demonstrated skills in innovative thinking
• Proven experience leading and managing change initiatives
• Expert understanding of the clinical process and data integrity requirements using technology
• Strong process improvement skills / experience
• Strong interpersonal, communication and relationship building skills across multiple audiences
• Strong data analytic and problem-solving skills
• Proficient with MS Office Suite: Excel, Word, PowerPoint, Outlook, Project and Visio
• Ability to hold individuals accountable and develop the ability to influence without authority
• Ability to act as a consultant to product, operations and technology partners
• Workers’ compensation claims experience is preferred

 

Education

• Bachelor’s degree in business or a related discipline, Master’s degree preferred
• A professional clinical degree or license is preferred

Additional Company Details:www.berkleymms.comThe Company is an equal employment opportunity employerWe do not accept any unsolicited resumes from external recruiting agencies or firms.The company offers a competitive compensation plan and robust benefits package for full time regular employees.The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.Additional Requirements:Travel Requirements•Domestic U.S. travel required (up to 10% of time)