Pharmacy Analyst Clinical & Client Operations

Your Future Evolves Here
Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.
Are we growing? Absolutely-62% in year-over-year revenue growth through 2015. Are we recognized? Definitely. We?re 12th on Forbes? list of America?s Most Promising Companies for 2015, one of ?Becker?s 150 Great Places to Work in Healthcare? in 2016, and our CEO was number one on Glassdoor?s 2015 Highest-Rated CEOs for Small and Medium Companies. If you?re looking for a place where your work can be personally and professionally rewarding, don?t just join a company with a mission. Join a mission with a company behind it.
This individual will play a critical role in executing Evolent Health?s mission by working hand in hand with the with Clinical & Client Operations ImplementationProject Manager as well as coordinate with Account Managers, Clinical Program Managers, other Operational staff, and client facing team members to identify and manage new benefits, benefit changes, and benefit testing.
This position is a remote role.
We are looking for team members that possess high energy, a strong work ethic, integrity, humor and who excel in a collaborative, team-oriented environment.
What You?ll Be Doing:
Coordinates formulary change process with internal and external partners (guidebook updates, website updates, communications, PA forms, UM Platform changes, Operations training)
Partners with Client Managers and LOB (Line of Business) Program Managers
Initiates Claim Reviews and identify coding issues for resolution
Coordinate both client and cross-functional (i.e., Evolent PBM Operations, Evolent Health Plan Operations, Key Partner Stakeholder, key vendors) operational teams to support benefit setup and implementation
Analyzes LOB competitive landscape for our partner markets
Primary testing resource of Benefits (Existing, New, and Changes)
Manages Source Documents and Creates Materials for Operational Staff
Assists with training of operational staff on new and changing benefits
Serves as a Subject Matter Expert on claim processing and rejections, secondary support personnel to the Pharmacy Resource desk
Ensure quality and service standards are met; including client contractual deliverables related to claims processing, conducts claims audits to identify issues
Identify process inefficiencies and provide innovative solutions to solve for gaps


The Experience You Need (Required):
Bachelor?s Degree in Business or other related discipline
1 years of health plan or pharmacy benefit or pharmacy operations experience
Intermediate to advanced skills with Outlook, Word, PowerPoint, and SharePoint
Advanced skills with Excel andor Access
Finishing Touches (Preferred):
Advanced ?business? degree (e.g., MBA, MHA, MPH)
3 years direct PBM benefits experience across both Commercial and Medicare Part D health plans
Proven track record to work in complex, and ambiguous situations
Evolent Health is an Equal OpportunityAffirmative Action Employer 3d0cba76329e4ca6ba476109ac4270d3

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