Description
Welcome to Montage Health's application process!
Job Description:
Position Overview: The Director of Pharmacy Services is accountable for all aspects of pharmacy strategy, tactics, and clinical operations for Aspire Health, and its pharmacy related partners and delegated organizations consistent with the development of the Company's strategic plans. This includes setting the strategic vision for Pharmacy Services within all Health Services functions, describing strategy, delivering pharmacy topic education, training and providing direction to pharmacy staff and health plan departments, and working with senior leadership throughout the organization to ensure corporate and Pharmacy Services goals are achieved. Key areas of focus for the position include managing Pharmacy cost across all lines of business, including benefit design, benefit administration, formulary development, contract negotiation, clinical vendor oversight, expansion of clinical pharmacy services, provider collaboration and member education. The position is chiefly responsible for managing pharmacy costs, improving pharmacy related quality performance (STARs and commercial/ACO quality metrics), reducing pharmacy operating costs and improving the health of the community, including effectively managing pharmacy interventions as an integral component of managing total cost of care. In all aspects of the position, it is the responsibility of the Director of Pharmacy Services to ensure compliance with all Federal, State and Aspire Health policies.
Essential Responsibilities:
Responsible to establish with Senior Leadership Team the overall strategy and tactics for the Company's pharmaceutical services and platform across all lines of business in all geographies. Responsible to provide input on companywide strategic initiatives. Accountable for managing the Pharmacy trend, cost, and utilization across all lines of business. Accountable for ensuring pharmacy benefit management capabilities are competitive in the marketplace and will support future growth. Responsible for clinical oversight of PBM and other contracted or delegated entities that support the Pharmacy function. Actively participate in various strategic and internal committees in order to disseminate information within the organization and represent company philosophy. Oversight of delegated P&T Committee and reporting of committee actions to Quality Improvement & Utilization Management Committee. Collaborate with prescribing providers to optimize the use of generics, lower cost alternatives, and to ensure providers follow the formulary to lower member cost and improve member experience. Collaborate with health plans partners, such as BSC advance practice pharmacy team Collaborate with the pharmacy teams of partner hospitals and medical groups. Accountable for hiring, staff development, coaching, performance reviews, corrective action and termination of employees within the Pharmacy Services department. Collaborates with other departments and leaders (UM, CM) to develop and roll out total cost of care initiatives. In partnership with Business Intelligence (BI) and HIT, develops actionable reporting to monitor and manage Pharmacy functions across all Aspire lines of business.
Conducts audits and produces reports that can be utilized by the care management, quality and compliance departments to evidence quality pharmacy services and meets Medicare requirements. Assists in defining, implementing and managing health plan pharmacy programs including the (Medicare) medication therapy and drug utilization management. Directly interfaces with the quality team by designing and monitoring tactics to improve pharmacy related STARs measures, medication reconciliation. Coordinates with other leaders within the organization on the overall approach to health services, pharmacy services, provider contracting, care management partnerships, and community health strategies, including total cost of care initiatives. Accountable for developing and monitoring annual department budgets. Accountable for ensuring Pharmacy management programs are in compliance with the terms of our contracts, as well as state and federal regulations and requirements. Accountable for establishing programs that promote positive working relationships, innovative approaches to care and reimbursement with providers, provider organizations, and Aspire Health team members. Accountable to provide relevant feedback on and analysis of local, state, and federal regulations that may impact Pharmacy and/or Aspire Health Operations. Accountable for timely and accurate responses to clinical pharmacy related inquiries by customer services, sales, brokers, and others that support membership growth and retention efforts. Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day. Follow the Aspire Health privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information. Perform other duties as assigned.
Work Experience: Five years of senior managerial experience in pharmaceutical industry leadership positions. Past experience with insurance pharmacy management and strategic direction or equivalent work experience. Senior Management policy and decision making experience, including developing and implementing management best practices is required. Prior experience of managing Pharmacy functions in Managed Medicare and/or Medicaid (MediCal) health plan required.
Education, Certificates, Licenses: Unrestricted license to practice pharmacy by the California State Board of Pharmacy and Doctor of Pharmacy degree required.
Knowledge: Comprehensive knowledge of business principles and techniques of administration, organization, and management to include an in-depth understanding of the key business issues that exist in the healthcare industry. Knowledge of strategic and operational planning. Healthcare economics. Personnel administration. Federal health reform laws. Financial and cost analysis. Trends in the healthcare industry. Delivery system transformation including medical home initiatives business process improvements, analysis and redesign. Excellent understanding of all areas of Pharmaceutical treatment. Possesses the ability to foresee changes in treatment patterns and implement internal systems as needed. Excellent understanding of the insurance industry (managed Medicare, MediCal, Commercial and ACOs) and risk factors and how they relate to the Aspire Health organization. The ability to identify, create, analyze, and implement innovative cost containment procedures. Excellent negotiating skills. Remains current in the Pharmacy field. Pro-active in the application of new Pharmacy systems and procedures and able to manage the efficiency and accuracy of the Pharmacy Services staff. Knowledge of local and regional Pharmacy community and practices. Expertise in quality assurance and utilization review. Basic computer skills preferred.
Competencies
Authenticity
Building Organizational Talent
Coaching and Developing Others
Cultivating Networks
Customer Focus
Empowerment/Delegation
Emotional Intelligence
Establishing Strategic Direction
Leading Change
Optimizing Diversity
Passion for Results
Environment: Work inside in a general office setting with ergonomically configured equipment. Local travel is required approximately 30% of the time.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Equal Opportunity Employer
#LI-AC1
Assigned Work Hours:
Full time (exempt)
Position Type:
RegularApply on company website
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