Why The Health Plan of West Virginia
FY2024 · Form 990Its mission and biggest programs, as filedImproves community health and well-being through technology-driven services and professional partnerships.
- The Health Plan offers a managed care program for mountain Health trust (mht), West virginia's medicaid program. At december 31, 2024, the Health plan's mht Plan serviced 100,002 members with 42,679 members enrolled from the expansion population, 41,915 members enrolled…$501M spent in FY2024
- The Health Plan offers a medicare advantage program known as secure care and a program for members eligible for both medicare and medicaid known as a medicare dual special needs Plan (dsnp). Secure care enables the medicare eligible population to…$136M spent in FY2024
- The primary exempt purpose of the Health Plan of West virgina, INC. (the Health Plan) is to operate a state certified, federally qualified Health maintenance organization (hmo) which provides comprehensive Health care services on a prepaid basis. The number of…$124.3M spent in FY2024
Before you apply
FY2024 · Form 990Independent: from IRS data, not the orgAbout the role
The org's own posting, as writtenThe Pharmacy Data Analyst will help the operation of Pharmacy Services run more effectively and efficiently through analyzing data from multiple sources (e.g., Express Scripts, Databytes, Ipro) as well as extract trends and business insights to improve health and financial outcomes of The Health Plan's population. The Pharmacy Data Analyst will also assist the unit with the plan benefit management and coding of multiple lines of business (Commercial, Exchange, Medicaid, and Medicare) within the pharmacy benefit adjudication platform. Required: Must possess a bachelor’s or master’s degree related to data analytics or at least one year experience in pharmacy and medical claim data reporting.
Proficient Microsoft Excel skills, including pivot tables, graphing, and complex formulas. Experience in data collection, analysis, and visualization methods. Must possess a working knowledge of quality improvement principles, theory, study design and statistical modeling. Flexible and able to multi-task, work in a fast-paced environment and adapt to changing processes. Self-motivated and goal oriented. Ability to work effectively as part of a team and independently. Proficient keyboarding skills and computer literacy with the ability to navigate through multiple systems. Ability to exercise independent and sound judgment in decision making, utilizing all relevant information and data.
Desired: Excellent oral, written, telephonic and interpersonal skills, balancing an independent and team working environment. Working knowledge of the PBM industry and pharmacy benefit claims. Certified Pharmacy Technician (CPhT) Experience creating automated reports, self-service tools and integrating multiple data inputs into a single dashboard (PowerBI). Skilled with mathematic problem solving and graphing. Intermediate to proficient skills working with SQL to extract data. Previous experience working in PBM environment, health plan, or managed care service organization.
Responsibilities
Integrate data from multiple sources to produce requested or required data elements which support continuous quality improvement leading to actionable information. Assist pharmacy team members with complex, detailed data needed projects. Interpret, analyze, and provide recommendations regarding data accuracy and data collection needs and processes. Research and identify data quality issues and work with internal and external partners to create a resolution. Work with business unit(s) to identify opportunities to enhance existing processes and to develop new data information processes and tools. Continuously assess and improve data collection and reporting processes.
Interfacing with, gathering information from, and preparing data for presentations to various levels of management, committees, internal and external. Work with designated department to assess, define, and develop report deliverables to meet internal and customer requirements. Reconcile daily eligibility file report with PBM and…
About The Health Plan of West Virginia
From its Form 990- Budget $772.7M
- Staff 643 · founded 1979
- Pays its leaders $241K–$691K (12 reported)
- Open jobs 19 · Jobs at The Health Plan of West Virginia · Full 990 report