About Us
McLaren Health Care, headquartered in Grand Blanc, Michigan, is a $7.3 billion, fully integrated health care delivery system committed to quality, evidence-based patient care and cost efficiency. The McLaren system includes 12 hospitals in Michigan, ambulatory surgery centers, imaging centers, a 640-member employed primary and specialty care physician network, commercial and Medicaid HMOs covering more than 732,838 lives in Michigan and Indiana, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, a National Cancer Institute-designated comprehensive cancer centers. McLaren has 20,000 full-, part-time and contracted employees and more than 113,000 network providers throughout Michigan, Indiana and Ohio.
Pharmacy Operations Analyst
McLaren Health Plan (MHP) is a company with a culture of high performance and a mission to help people live healthier and more satisfying lives. We are looking for an Operations Analyst to join in leading the organization forward.
MHP is a Managed Care Organization dedicated to meeting the health care needs of each member. MHP offers multiple product lines, including individual and family plans, and Medicaid and Medicare plans to Michigan residents for every stage of life. McLaren Health Plan is accredited by the National Committee for Quality Assurance (NCQA).
MHP values the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plan can thrive. As an employee of MHP, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.
Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org
Position Summary:
The Operations Analyst combines executive-level support with hands-on operational execution to advance the strategic and day-to-day priorities of the health plan. This role provides end-to-end support for organizational initiatives and process improvements across all functions of the health plan. This individual will work with leaders across all departments to ensure operational compliance, alignment on goals, and timely execution of priority initiatives. The role manages executive-level communications, prepares leadership materials, completes special assignments, and supports high-visibility projects that require discretion, accuracy, and professionalism. Responds to inquires, provides information, and independently resolves basic problems. Responsible for assisting in development of operating policies and procedures, taking and maintaining minutes of various committees, posting of announcements, and compiling and maintaining recurring and miscellaneous reports. Acts as a liaison with internal and external departments.
Position Specific Expectations:
Pharmacy Operations
Prepare and submit pharmacy-related regulatory reports and state submissions required by MDHHS for the Medicaid managed care contract, including pharmacy utilization data, encounter data, and quality reporting.
Support CMS Medicare Part D reporting requirements, including PDE (Prescription Drug Event) data reconciliation and Part D compliance reporting.
Conduct pharmacy claim audits, including retrospective drug utilization review (RDUR) analyses, pharmacy network compliance audits, and PBM performance data validation.
Track and report on pharmacy cost savings initiatives, including generic substitution rates, formulary adherence, specialty drug management programs, and rebate performance.
Monitor pharmacy benefit trend data and identify aberrant utilization patterns, outlier prescribers, and potential fraud, waste, and abuse (FWA) indicators for escalation.
Support internal and external pharmacy audits, including MDHHS Medicaid managed care audits, CMS program audits, and NCQA accreditation reviews.
Support the development of pharmacy program presentations, including board reports, regulatory submissions, and internal leadership briefings.
Research and analyze pharmacy benefit best practices, regulatory updates, and market benchmarks to inform program development.
Maintain documentation of audit findings, corrective action plan tracking, and remediation status for pharmacy-related compliance activities.
Qualifications:
Required:
- Associate degree in business administration, healthcare administration, or other administrative support area; or High School diploma or equivalent (GED) and two (2) years' experience in a related field.
- Two (2) years' experience in an office environment related to customer service.
- Proficiency with computer applications, MS-Office, automation tools, and other software applications associated with Operations department functions.
Preferred:
- Bachelor’s degree in business administration, healthcare administration, or related field.
- Experience and knowledge of HMO, PPO, TPA, and Managed Care functions (e.g. quality improvement, regulatory compliance, utilization management, care management, claims processing, payment integrity, enrollment/eligibility, EDI, provider contracting, and risk arrangements).
Equal Opportunity Employer
McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status, national origin, disability, genetic information, height or weight, protected veteran or other classification protected by law.
