Operations Manager Rx Jobs in Santa Ana, CA (NOW HIRING)

Your Role

The Pharmacy Markets, Products, Analytics and Strategies (RxMAPS) team is responsible for leading and collaborating cross-functionally with key stakeholders across Pharmacy Strategy and Operations at Blue Shield of California (BSC). The Rx Analytics and Reporting team drives analytic strategy and performs clinical and business analyses to provide consultations and strategic program recommendations. The Manager, Medical Informatics, Operational Analytics will report to the Senior Manager, Rx Analytics and Reporting. In this role you will either lead Line of Business (LOB) and Employer Group Analytics or Operational Analytics.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies. 

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience. 

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!  

Our Values: 

• Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short. 
• Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals. 

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail. 

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

Your Knowledge and Experience

• Requires a college degree or equivalent experience
• Requires 7 years of prior relevant experience, and 5 years of experience as a Health Data Analyst, Medical Economist, or in a related role within a healthcare setting. Additionally, 5 years of experience in pharmacy benefit management and managed care health plan working with large pharmacy and medical claims data sets is required
• Requires 3 years of management experience gained as a team leader, supervisor, or project/program manager
• Experience with other pharmacy data (e.g., pharmacy and medical rebates, pharmacy networks, prior authorization) is preferred
• Data analytic skills with Microsoft Office (e.g., Excel and Access) and other data analytic tools (e.g., SQL, SAS Viya, Snowflake SQL, Tableau)
• Ability to leverage business and data knowledge to interpret health plan benefit utilization
• Excellent presentation, verbal and written skills with ability to understand and convey complex ideas to an audience with diverse backgrounds

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.
Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

Your Work 
In this role, you will:

• Be responsible for Medical Informatics results in terms of performance, planning and approach
• Ensure workflow, operation, procedures and guidelines are clearly documented and communicated
• Oversee the development and implementation of new approaches and standard reporting capabilities in conjunction with the implementation of new/existing technologies 
• Support Medical Informatics leadership in meeting strategic goals
• Communicate project status, progress, and outcomes to senior management
• Serve as a BSC Pharmacy Services contact and subject matter expert to stakeholders, and manage external relationships (vendors, clients) related to assigned work
• Develop, analyze & monitor prescription drug, medical claims, and program data to identify opportunities to improve quality and cost of healthcare and to monitor/report performance and outcomes
• Drive team strategy around self-service reporting tools (e.g., Tableau, SAS Viya, etc.)
• Support Modular Solution Operating Model, including working with Rx Claim Exchange and Data Services teams on data incidents, User Acceptance Testing, financial contract management, and Experience Cube (data warehouse) build
• Support pharmacy strategic initiatives, as needed
• Lead Pharmacy Product Line of Business Analytics & Reporting (e.g., Individual and Family Plans, Small Group, Large Group, and Medicare)
• Lead Pharmacy Employer Group Analytics & Reporting
• Support Pharmacy data questions for Requests for Proposals and Requests for Information (coordinate with Pharmacy Accounts & Sales and Actuarial teams, as needed)
• Lead Mandate Submissions (CAA Sec 204, CMS DIR, SB-17, MCAS, RDS, OHCA, HPD NCP)
• Support Operational and Cost of Health Care analytics, as needed