Manager, Clinical Pharmacy Operations

Job ID: J121079
Company: Highmark Inc
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Apr 12, 2018

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Description

JOB SUMMARY (Summarizes the major purpose and primary responsibilities)

This job will be accountable for the clinical pharmacy operations area, specifically the clinical team of pharmacists who support the pharmacy operations team.  This job will work closely with the clinical pharmacy strategies and other pharmacy strategy teams to execute on the formulary/utilization (UM) and other strategic pharmacy products.  This  job will be responsible for managing each of the pharmacists who will drive member engagement with the goal of lowering care costs associated with the Organization's drug utilization across both the pharmacy as well as the medical benefits.  This job will have a strong compliance focus to ensure adherence to CMS turnaround times for ACA and MA members and overall handling of medication requests. Additional responsibilities will include adherence to other quality and regulatory requirements including, but not limited to, NCQA, DOH, and additional state-specific mandates.

ESSENTIAL RESPONSIBILITIES (Describes the critical tasks, duties and responsibilities of the position.)

  • Performs management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.
  • Plans, organizes, staffs, directs and controls the day-to-day operations of the department; develops and implements policies and programs as necessary; may have budgetary responsibility and authority.
  • Provides direction to a team of clinical pharmacists as members of a multi-stakeholder care team responsible for ensuring appropriate drug utilization across the pharmacy and medical benefit with the goal of lowering drug care costs as it relates to the operations of the Organization's formularies and UM processes such as prior authorizations, exceptions, and  other applicable pharmacy edits.
  • Ensures adherence to all regulatory and compliance guidelines (CMS, NCQA, DOH, etc.) as it pertains to the pharmacy UM operations functions, turnaround time and overall handling of pharmacy UM/formulary requests.
  • Collaborates with the pharmacy organization to ensure that operational impacts of pharmacy UM and formulary policies as well as other pharmacy strategic programs can be accommodated by the operations area.
  • Other duties as assigned or requested.

REQUIRED EDUCATION

Bachelor's Degree- Pharmacy

Substitutions (Acceptable substitutions in lieu of a degree 1 ½ years’ experience  = 1 year college)

No substitutions

PREFERRED EDUCATION

Pharmacy

EXPERIENCE

Minimum: This section refers to the minimum years and type of applicable experience needed to perform the job.  Minimum requirements must be non-comparative, objective, and relevant.

Preferred: This section refers to additional desired years and type of experience that the hiring manager would prefer, above and beyond the basic requirements of the job.

3 or more years' of experience of clinical pharmacy management experience including drug use review activities, operational oversight and/or memberengagement

3 or more years' of experience in managed care pharmacy and/or pharmacy benefit management (PBM)

1 or more years' of experience in a leadership role with demonstrated success in building a collaborative team with measurable outcomes related to operational metrics

Experience with regulatory entities such as CMS, NCQA, HEDIS, DOH etc.

1 or more years' experience in managing or supervising clinicians (such as pharmacists, nurses, or other clinicians) in a utilization management operations setting in a PBM or Health Plan.

KNOWLEDGE, SKILLS & ABILITIES (List the attributes required to perform the job through demonstrated service, education or training)

  • Strong analytic skills with ability to interpret, evaluate and act on productivity, clinical and financial data. Six sigma belt preferred.
  • Strong leadership skills with demonstrated success in building effective, collaborative teams
  • Ability to work in a high performing team environment that requires flexibility
  • Excellent interpersonal and communication skills and the ability to work in a matrix management environment
  • Excellent presentation skills both verbal and written and the ability to communicate with all levels of the organization

REQUIRED LICENSURE (Licenses that are required to perform the job)

Registered Pharmacist

PREFERRED LICENSURE

TRAVEL REQUIREMENT:  0%  - 25%
(List % of time traveling)

LANGUAGE REQUIREMENT (other than English)?  
(List primary language)

PHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONS
(The physical, mental demands and working conditions described here are representative of those that must be met by an employee to successfully perform the essential function of their job. Reasonable accommodations will be made when necessary to enable individuals with disabilities to perform the essential duties of the position, to the extent that they do not cause undue hardship.

Position Type:

Office-Based

Office-Based Positions

An employee in this position works in an office environment.  The position frequently requires the employee to communicate effectively with others both inside and outside the workplace (e.g., in person, via telephone, via email).  The employee must be able to understand, interpret and analyze data, solve problems, concentrate, and research, use available technological resources and systems (e.g., computers and computer programs), multi-task, prioritize, and meet multiple deadlines to complete essential tasks.  The employee generally works in a fast-paced and frequently stressful environment, must attend work on a regular and reliable basis as well as adhere to all workplace policies, and may be called upon to work outside regular business hours.

Teaches/Trains others regularly  Does Not Apply

Travels regularly from the office to various work sites or from site-to-site  Does Not Apply

Works primarily out-of-the office selling products/services (Sales employees)  Does Not Apply

Physical Work Site Required - No

Most On-The-Road Positions

An employee in this position may work in a home or company office environment but is also frequently driving to and from various locations to perform the work off-site.  The position frequently requires the employee to communicate effectively with others both inside and outside the workplace (e.g., in person, via telephone, via email).  The employee must be able to understand, interpret and analyze data, solve problems, concentrate, and research, use available technological resources and systems (e.g., computers and computer programs), multi-task, prioritize, and meet multiple deadlines to complete essential tasks.  The employee generally works in a fast-paced and frequently stressful environment, must attend work on a regular and reliable basis as well as adhere to all workplace policies, and may be called upon to work outside regular business hours.

Non-Office-Based Positions

An employee in this position is frequently required to move throughout the workplace, sit, stand and walk, use hands and fingers to hold objects, tools or controls, possess fine motor skills (e.g., to write and operate a computer or to steer transportation equipment), possess gross motor skills (e.g., to carry items), reach with hands and arms, climb stairs and ladders, balance, stoop, kneel crouch and crawl, communicate effectively, and talk and hear. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.  The employee must be able to work in a busy environment where decisions often must be made quickly, must attend work on a regular and reliable basis, must adhere to all workplace policies, and may be called upon to work outside regular business hours.  This work occurs in a [example: warehouse, hospital or provider’s office or mail room].

Lifting: up to 10 pounds  Does Not Apply

Lifting: 10 to 25 pounds  Does Not Apply

Lifting: 25 to 50 pounds  Does Not Apply

ADDITIONAL INFORMATION

Changes Approved By:

Melanie Lysne

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

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