We are seeking a Pharmacy Director who will report directly to the AVP of Pharmacy, is a member of the Pharmacy Senior Leadership Team (PSLT), and is accountable for visioning and leading company Health Plan pharmacy program strategy, development and implementations, including: Clinical Pharmacy Programs, Pharmacy and Therapeutics Committee, Formulary, Pharmacy Rebate Management, and Pharmacy Systems Administration and Emerging Technologies. The Director supports the AVP of Pharmacy in pharmacy benefit administration and strategy delivered through the company Health Plan.
In this position you will have the following responsibilities:
Evaluates, reviews, negotiates and manages such pharmacy contracts and pharmacy provider relations programs as may be necessary in a managed care environment utilizing assigned staff.
Evaluates, develops, prioritizes, implements, manages, and oversees such programs as needed to assure the availability of an ambulatory formulary management program and related evidence based drug therapy utilization initiatives.
Plans, controls, leads, directs, and manages such business relationships and programs that are necessary for successful pharmacy program management. Pharmacy program management includes pharmacy benefit management companies (PBMs), third party administrators (TPAs, electronic prescription claims adjudicators, internal manager, pharmacist, nurse, and technician supervision & management, and such other activities that are necessary to provide necessary oversight and direction to a successful health plan pharmacy program.
Plans, controls, leads, directs and modifies new and established pharmacy projects - including cost saving pharmacy programs - that assist us in meeting its financial and quality goals.
Recommends and participates in outpatient prescription drug benefit decision making and manages development of systems that can impact overall drug costs and trend.
Directs the provision of 'member at risk programs' and medication compliance and management systems in consultation with physicians and pharmacists.
Directs, manages, and supervises Pharmacy Services Department within the company. Employees supervised include pharmacy technicians, clinical pharmacy coordinators/business analysts, clinical pharmacist specialists.
Directs rebate strategy and performance management as a means by which to manage prescription drug trend.
Directs and manages Drug Utilization (DUR), medication recall programs, adverse drug reaction reporting systems, medication management initiatives for high risk members/patients in a manner consistent with the scope of the Pharmacy Director position.
Directs the development, implementation, and monitoring of pharmacy network management program, including pharmacy network pricing.
Participates on the Ambulatory Pharmacy and Therapeutics Committee (P&T) as well as the Quality Management Standards Committee, QMM Steering Committee and such other operational and/or programmatic committees and workgroups as may be necessary to fulfill the requirements.
Directs prioritization, development and implementation of a drug prior authorization program and various drug therapy initiatives. Directs development of step therapy protocols, prescription utilization guidelines and medical & pharmacy policies.
Directs, monitors and maintains quality of Pharmacy Services according to standards developed and approved by the Quality Management Standards Committee.
Directs, develops and communicates medication management needs as well as, ambulatory pharmacy issues and opportunities to health system pharmacy directors and medical directors in a manner that promotes and supports quality of care initiatives as well as stewardship initiatives.
Directs and coordinates the provision of physician education, monitoring, and profiling tools geared toward enhancing the provision of quality cost-effective medication management, as well as member drug usage profiling.
Directs and manages auditing of prescription claims processing, as well as J-code and specialty injectable medication provision. Oversees such programs and processes as may be necessary to assure accurate, quality provision of pharmacy services administered under the medical portion of the health plan benefit.
Direct and Collaborate with Health System communications and regulatory entities pertaining to pharmacy and medication use.
Directs and responds to marketing RFPs regarding pharmacy benefit requests and contractual changes.
Directs and determines data analysis and utilization in collaboration with analysts, medical directors, financial analysts, and underwriters to assure meaningful use and interpretation of prescription drug data.
Directs and decides, collaborates, and identifies opportunities for case management, concurrent review, and disease management to obtain essential clinical pharmacy coordinator services or consultation in those arenas or situations requiring the expertise of a pharmacist.
Directs and decides, collaborates, and identifies methodologies and systems for financial management of pharmacy program spend. Such activities are taken on in cooperation with Informatics and Risk & Reimbursement (Finance).
Decides, collaborates, and identifies and implements opportunities to enhances overall PHS drug therapy management systems from both a quality and cost perspective. This is done by working with other health system pharmacy directors, medical directors, and key programmatic or department directors.
Sponsors Pharmacy Agile Information Services Team.
Leads Managers & Senior Managers in pharmacy resource allocation and prioritization.
Required qualifications for this position include:
Post-graduate PGY-1 & PGY-2 residency.
10 or more years experience in ambulatory or acute care pharmacy practice with responsibility for drug therapy evidence assessment and/or formulary management, as well as direct consultation and presentation of medication information and recommendation to physicians and/or patients.
5 years managed care pharmacy experience.
8 years progressively responsible experience in managed care or ambulatory care leadership including direct supervision and successful development of individual contributors and front line managers.
Demonstrated experience must also include the following core areas: contracting; pharmacy benefit administration and rebate management; pharmacy medical policy prior authorization, prescription benefit design; home infusion, hospice; specialty injectable medication management, medication case management strategies, and collaboration with various disciplines to assure the provision of coordinated care utilizing evidence-based best practices.
3 years experience in vendor management oversight and performance.
Experience working with pharmacy information systems and collaboration with IS divisions.
Experience working with complex pharmacy and medical diagnoses data sets in pivot tables and Tableau in consultation with highly skilled analysts responsible for using these data sets to inform reporting that leads to decisions and prioritization of high value work and initiatives that achieve desired clinical, utilization, and financial outcomes.
Operational and clinical experience in the key internal and external relationships and strategies necessary to effectively manage pharmacy spend.
Comprehensive negotiation and contractual management experience in participating pharmacy network development & retention, electronic prescription claims adjudication, prescription rebate revenue processes & retention, clinical pharmacy service contracts, pharmaceutical company oversight, and such other oversight necessary to administer benefits for managing prescription and other medication use within managed care setting.
Comprehensive experience in managing an ambulatory formulary as well as programs and systems for drug use evaluation, medication management initiatives, adverse drug reaction reporting, medication error reporting, and medication recall administration.
Experience leading and mentoring managers responsible for core services.
Experience supervising & managing licensed pharmacy technicians, pharmacy coordinators/business analysts, and licensed clinical pharmacist specialists and program managers.
Comprehensive experience implementing and managing programs that require consultation, coordination, collaboration, recommendation, and monitoring of drug therapy initiatives, guidelines, protocols, and quality improvement projects by employed physicians and pharmacists, as well as other physicians, pharmacists, and health care providers.
Expert experience in leadership and management of prescription drug benefits and medication aspects of medical benefit management.
Clinical and financial management experience utilizing multiple data sources that are necessary to document "return on investment" associated with implemented and planned projects and programs.
Experience with 5-Star metrics & measurement and NCQA accreditation.
E-prescribing, real-time benefit, and e-technology platform experience to include automated POS pharmacy claims administration and automated pharmacy prior authorization and formulary tools.
Current licensure without sanctions by Oregon State Board of Pharmacy or eligible to meet requirements before employment.
Preferred qualifications for this position include:
Specialty residency or fellowship.
Very competitive salary and benefits!
Great company to work for!
Full relocation package is available!
Don't miss out! Apply now and we'll be in touch immediately with more specific details, salary information and to answer any questions!!
This position does NOT provide sponsorship so please do NOT apply if you require sponsorship. Thank You
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