Retail
Pharmacy - Managed Care Services Director
Job Information
Company
Sears Holdings Management Corporation
Location
US-IL-Hoffman Estates
Job Title
Pharmacy - Managed Care Services Director
Job Type
Pharmaceutical
Retail
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Job Title
Pharmacy - Managed Care Services Director
Job Description
Responsible for obtaining, reviewing, and negotiating all third party contracts.
Directs the establishment, communication and implementation of third party contracts into all Kmart pharmacies. Directs third party pharmacy receivable staff to ensure financial data is analyzed and reported in a timely and accurate manner.
Job Requirements
1.Develops the claims processing function. Responsible for plan set up, claim submission, rejections, payments, accounts receivable and general ledger reporting.2.Reviews all third party contracts signed by Kmart. Responsible for these contracts from receipt through negotiation, pro forma, legal review, management review, corporate signatures and final implementation into an agency contract database.3.Manages all billing activities for third party plans. Responsible for accurate reimbursements, correct and timely payments and measuring short and long term impact on gross margins.4.Reviews pharmacy account/database reconciliations.5.Implements appropriate action and procedures to reduce outstanding receivable balances and uncollectible balances.6.Works in conjunction with multiple departments (accounting, marketing/sales, operations and information technology) on business issues and detailed solutions.7.Verifies and maintains third party profit and loss figures for all Kmart pharmacies.Director of Managed Care Services8. Ensures receivables staff compliance with policies, programs and procedures to optimize department performance and effectiveness.9. Develops reports and reporting procedures to accurately portray various organization performance results in an effective and timely manner.10. Coordinate the pharmacy third party audits and audit response process. Utilizes audit results to create initiatives and improved editing capabilities to reduce the frequency and value of future audits.11.Manages editing capabilities to ensure compliance with dispensing regulations and to optimize third party contract performance.KNOWLEDGE, SKILLS AND ABILITIES REQUIRED TO PERFORM ESSENTIAL FUNCTIONS:1.Bachelor’s degree in business administration or equivalent.2.Five (5) to seven (7) years retail pharmacy experience or equivalent.3.Advanced knowledge and use of Windows-based personal computer, effective MS Office skills.4.Strong organizational, analytical, interpersonal and communication (oral and written) skills.
Benefits
A comprehensive and competitive benefit program is designed to meet the needs of our associates and their families. Benefits eligibility depends on employment classification, location, and other variables. Benefits offered include:
An Equal Employment Opportunity Employer.
About Sears Holdings Management Corporation Sears Holdings Management Corporation provides corporate services to Sears Holdings Corporation (NASDAQ: SHLD) and its family of companies, including Sears Roebuck and Co. and Kmart Corporation.
About Sears Holdings Corporation Sears Holdings Corporation is the nation's fourth largest broadline retailer with over 4,000 full-line and specialty retail stores in the United States and Canada. Sears Holdings is the leading home appliance retailer as well as a leader in tools, lawn and garden, consumer electronics and automotive repair and maintenance. Sears Holdings is the 2011 ENERGY STAR® Retail Partner of the Year. Key proprietary brands include Kenmore, Craftsman and DieHard, and a broad apparel offering, including such well-known labels as Lands' End, Jaclyn Smith and Joe Boxer, as well as the Apostrophe and Covington brands. It also has the Country Living collection, which is offered by Sears and Kmart. We are the nation's largest provider of home services, with more than 11 million service calls made annually. Sears Holdings Corporation operates through its subsidiaries, including Sears, Roebuck and Co. and Kmart Corporation. For more information, visit Sears Holdings' website at www.searsholdings.com.
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