Insight Health System is a physician-led organization focused on advancing excellence in healthcare and community well-being. Our expertise is in transforming distressed hospitals into stable, patient-centric care that is second to none. With a track record for innovation in healthcare, research and development, Insight Health System provides the communities we serve with world-class healthcare services at the forefront of medical technology. Our network currently includes a portfolio of entities encompassing six acute care hospitals (three of which are nonprofit), six surgery centers, 28 clinics, 580 physicians, 10 unions, and 4,200 employees. Collectively, Insight Health System hospitals provide nearly 100,000 patient days annually.
Position Overview
We are seeking a highly organized and operations-driven Pharmacy Business Operations Manager to oversee inpatient and outpatient pharmacy functions across our Michigan locations, including Flint, Warren, and Coldwater. This role ensures all pharmacy operations run efficiently—covering claims oversight, credentialing, shipping workflows, staffing, regulatory readiness, and 340B support. The ideal candidate will lead multi-site pharmacy operations, strengthen financial and operational performance, and ensure seamless coordination between inpatient and outpatient teams.
Benefits:
- Comprehensive health, dental, and vision insurance
- Paid time off: vacation, holidays, and sick leave
- 401(k) with employer match (immediate vesting; eligibility begins after 3 months)
- Employer - paid short - and long - term disability, basic life insurance
- Voluntary coverages: accident, critical illness, hospital indemnity, AD&D, etc.
Key Responsibilities:
- Operational Leadership & Multi-Site Oversight
- Oversee daily pharmacy operations for outpatient and inpatient locations in Flint, Warren, and Coldwater.
- Ensure smooth and compliant workflows across all sites, including inventory, ordering, dispensing, shipping, and staffing.
- Maintain communication with inpatient pharmacy leadership to ensure medications are appropriately ordered, stocked, and reconciled.
- Support licensure expansion into additional states for outpatient pharmacy services.
Claims, Billing & 340B Support
- Monitor and track all pharmacy claims across TPAs, PBMs, and payors to ensure accurate adjudication.
- Verify credentialing status for all pharmacies and ensure all payor enrollments remain active and compliant.
- Oversee 340B–related workflows, including auto-billing validation, claim matching, diversion/exclusion checks, and pharmacy–covered entity coordination.
- Identify discrepancies, underpaid claims, or missed revenue opportunities and escalate/resolution as needed.
Shipping & Fulfillment Oversight
- Ensure shipping operations are timely, compliant, accurate, and aligned with pharmacy standards.
- Monitor packaging, routing, temperature control, and tracking processes to maintain quality and patient safety.
- Develop improvements to increase speed, accuracy, and cost-effectiveness.
Staffing, Hiring & Team Management
- Lead hiring efforts for pharmacists, pharmacy technicians, and support staff across all Michigan locations.
- Support new hire onboarding, training, performance expectations, and workflow alignment.
- Ensure proper staffing models are maintained to support volume and growth.
Growth & Outpatient Pharmacy Development
- Drive growth of the outpatient pharmacy through optimization of workflows, patient engagement strategies, and provider alignment.
- Work with business development, clinical teams, and operations leaders to expand outpatient pharmacy services.
- Monitor KPIs, including volume, turnaround time, claim success rates, acquisition cost trends, and margin performance.
Regulatory, Compliance & Credentialing Coordination
- Maintain up-to-date licenses, permits, payor contracts, enrollments, and state board requirements for all pharmacy locations.
- Ensure compliance with all Michigan and federal regulations, including pharmacy board rules, USP standards, and applicable accreditation standards.
- Prepare documentation and support audits, inspections, and regulatory reviews.
Cross-Functional Collaboration
- Partner with finance, operations, compliance, HR, inpatient pharmacy, outpatient pharmacy, and leadership teams to ensure alignment and execution.
- Serve as a primary point of contact for all pharmacy operational issues across Michigan locations.
- Step in to support staffing or operational needs during high-volume periods.
Required Qualifications
- Bachelor’s degree in Pharmacy, Business Administration, Healthcare Administration, or related field.
- Strong operational, organizational, and project management skills.
- Experience in pharmacy operations (inpatient, outpatient, or specialty).
- Ability to manage multiple sites, workflows, and competing priorities.
- Excellent communication, documentation, and leadership abilities.
Preferred Qualifications
- Multi-site pharmacy management experience strongly preferred.
- Understanding of pharmacy claims, TPAs, PBMs, and reimbursement models.
- Working knowledge of 340B operations and auto-billing workflows.
- Background in pharmacy credentialing, licensing, and payor enrollment.
- Experience managing shipping/fulfillment operations in a pharmacy environment.
- Familiarity with USP <797>/<800>, Michigan Board of Pharmacy requirements, and outpatient/inpatient operations.
- Experience supporting pharmacy growth initiatives or expansion projects.
Insight is an equal opportunity employer and values workplace diversity!
