Director Clinical Pharmacy Operations

Job ID: J138826
Company: Highmark Inc
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Jan 14, 2019

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Description

JOB SUMMARY

The job will be accountable for all of the health plan's clinical pharmacy operations including the clinical and non-clinical support within the operations team.  This job will work closely with the pharmacy strategy teams to execute on the formulary/utilization management (UM) and other strategic pharmacy products.  The job will also be responsible for pharmacists as a component of a multi-stakeholder care team that will drive member engagement with the goal of lowering care costs associated with the Organization's drug utilization across the medical and pharmacy benefits.  This position will be responsible for the non-clinical staff that are a component of the overall pharmacy UM processes to intake medication requests from members and providers.  The job will have a strong compliance focus to ensure adherence to ACA and MA regulations around turn-around time and overall handling of medication requests.

ESSENTIAL RESPONSIBILITIES

  • 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 clinical and non-clinical staff as it relates to the operations of Highmark's formulary and UM process, which includes formulary exceptions, prior authorization and other clinical pharmacy edits.
  • 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.
  • 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.
  • Builds an effective team that allows for cross-training and flexing of staff resources in order to adjust based on demand for operations focus vs. pharmacy care and case management functions.
  • 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

PREFERRED EDUCATION

Master's Degree - Pharmacy

REQUIRED LICENSURE

Registered Pharmacist

EXPERIENCE

Minimum:.

  • 7 or more years' of experience of clinical pharmacy management experience including drug use review activities, operational oversight and/or member engagement
  • 5 or more years' of experience in managed care pharmacy and/or pharmacy benefit management (PBM)
  • 5 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.

Preferred:

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

Referral Bonus: Level 4

Summary

The job will be accountable for all of the health plan's clinical pharmacy operations including the clinical and non-clinical support within the operations team. This job will work closely with the pharmacy strategy teams to execute on the formulary/utilization management (UM) and other strategic pharmacy products. The job will also be responsible for pharmacists as a component of a multi-stakeholder care team that will drive member engagement with the goal of lowering care costs associated with the Organization's drug utilization across the medical and pharmacy benefits. This position will be responsible for the non-clinical staff that are a component of the overall pharmacy UM processes to intake medication requests from members and providers. The job will have a strong compliance focus to ensure adherence to ACA and MA regulations around turn-around time and overall handling of medication requests.

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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