Longevity Health is growing rapidly and is looking to add new talent to our team. Longevity Health currently has operations in Colorado, Florida, Georgia, Illinois, Michigan, New Jersey, New York, North Carolina, Ohio, Pennsylvania, South Carolina, and Texas, with plans to start-up operations in other states in the very near future. Due to our rapid growth, we have an immediate need for a Pharmacy Operations Analyst. 

 

General Purpose: The individual holding this position is required to support and demonstrate their commitment to the Longevity Health Statement of Purpose, which is: To improve the health and quality of life of nursing home residents by caring for their unique medical, social and emotional needs.

The Pharmacy Operations Analyst is a dynamic, supportive role in the management of the Pharmacy operations for Longevity Health’s Special Needs markets. The analyst will support pharmacy operations delegated services, including PBM and TPA functions, to ensure member access to Pharmacy benefits during their residence in a Special Needs setting. They will perform research for claims adjudication, eligibility, and formulary management and STAR metrics. The analyst must have the ability to recognize opportunities, initiate and implement changes to improve current processes and member outcomes based on medication trends, utilization, costs, and top indications.

This position requires effective communication with other departments and providers in the facilities to achieve program goals. The Pharmacy Operations Analyst will assist with program compliance based on CMS Part D regulations. The ideal candidate must be detail‐oriented, intellectually curious, can challenge the status quo, think critically, problem solve, and work in a fast‐paced environment with shifting priorities.

 

Key Tasks and Responsibilities:

• Analyze and interpret data to identify erroneous execution of the pharmacy benefit by the PBM, to include:
  • Daily Rejected Claims
  • CDAG
  • Transition Supply
  • Eligibility
  • PDE / LICs Edits
  • ESRD / Hospice
  • FWA
  • Formulary Management
  • STAR Measures
    • Medication Adherence
    • MTM
• Serve as a PBM liaison and other internal teams for real‐time support on pharmacy benefit interpretation or issues.
• Support internal and external audit processes as related to CMS, NCQA, and HEDIS program requirements.
• Develops and maintains requirements, user stories, test scenarios and test cases; support testing execution and defect management.
• Identify and assist to remediate gaps and/or deficiencies in current pharmacy processes, tools, reports, and dashboards.
• Develop and maintain job aids and Policy & Procedures (P&P) documents for the Pharmacy Operations program.
• Performs other related duties as assigned.

 

Credentials & Coverage:

• National Certified Pharmacy Technician (CPhT) certification, preferred.
• Valid state driver’s license with a good driving record and proof of automobile insurance required.
• Auto liability insurance coverage per minimum required by home state.

 

Education and Training:

• Bachelor’s degree, or Associates with relevant experience and/or certifications.
• 3‐5 years' experience in a PBM environment preferred.

 

Knowledge and Experience:

• Knowledge of Medicare, Long Term Care / Special Needs Plans.
• Knowledge of pharmacy claims data, Coverage Determinations, Appeals and Grievances (CDAG).
• Proficient in Microsoft Word, PowerPoint, Excel.

 

Company Overview:

Founded in 2018, Longevity Health started as an Institutional Special Needs Plan (ISNP), a type of Medicare Advantage health plan that addresses significant unmet needs of long-term institutionalized members who reside in nursing homes.  Through rapid growth from 2018 to 2022, we expanded our market footprint and currently offer ISNP Medicare Advantage plans in Colorado, Florida, Illinois, Michigan, New Jersey, New York, and North Carolina. 

In 2023, we expanded our service offerings to the broader health plan market.  In addition to our existing markets where we are both the ISNP and the care management team, we are now partnering with National Carriers on their offered ISNP plans in Ohio, Pennsylvania, upstate New York, Georgia, South Carolina, and Texas, with implementations in progress for several other additional US states. This allows us to utilize our core skills of supporting clinical post-acute needs of this vulnerable senior population Currently 13 markets and expanding rapidly.

 

Company Disclaimers:

Longevity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law.

It is the policy of Longevity Health to follow Federal and / or State regulations surrounding COVID vaccinations.  While CMS guidelines have been relaxed, there are some LHP facilities which will still require staff be vaccinated in an effort to protect the health of the members / patients we serve.  If your assigned location(s) require all staff to be fully vaccinated, you are required to obtain and / or provide documentation related to your COVID vaccination.  To confirm whether your assigned location(s) require COVID vaccinations, please refer to the Facility Guide Job Aid located on Longevity Health Plan’s intranet site. 

The Company will engage in an interactive process with individuals who cannot be vaccinated for medical or sincerely held religious beliefs to determine if a reasonable accommodation can be made. While an exemption/accommodation may be initially granted, if at any time during employment, it is determined that an exemption/accommodation that has been granted is no longer considered a reasonable accommodation, it can result in employment with the Company ending.

Candidates must meet the Company’s hiring criteria which include a pre-employment background and drug screening.

Longevity Health offers a competitive compensation and benefits package which includes medical, dental, vision, short and long-term disability, life insurance, and 401(k).

Submission of false information during the application process may result in immediate termination of employment without notice.