Manager Pharmacy Clinical OPS

4 weeks ago

Hanover, United States Johns Hopkins Medicine Full time

Johns Hopkins Health Plans is a leader in provider-sponsored health plans. If you are interested in improving how healthcare is delivered, and have a passion to be at the forefront of change, JHHP is the place to call home. YOU belong here.

What awaits you:

  • Work-life balance - This is a hybrid role requiring you to work 1 day per week in the Hanover, MD office
  • Medical, Dental, and Vision Insurance.
  • 403B Savings Plan w/employer contribution.
  • Paid Time off & Paid holidays.
  • Employee and Dependent Tuition assistance benefits.
  • Health and wellness programs and MORE

As a Manager of Clinical Pharmacy Operations, you’ll:

  • Review prior authorizations and non-formulary requests to ensure the efficient delivery, clinical appropriateness, and optimization of care; including assisting in the management of work process flows.
  • Manage and develop direct reports who include other supervisory personnel and ensures the delivery of superior pharmacy operations service and member satisfaction.
  • Develop, manage, and monitor performance for production, quality, and compliance. (i.e.: clinical criteria justifications, prior authorization / non-formulary review decisions and application of department workflow processes).
  • Hire, train, coache, counsel, and evaluate performance of direct reports.
  • Report and analyze clinical audit productivity and trends and develop and executes corrective actions as needed.
  • Partner with department leadership to review, develop and ensure execution on departmental policies and procedures in conjunction with all state, federal, and contractual requirements and that authorization/non-formulary requests are handled within all federal and state regulatory compliance time frames.
  • Lead and present at assigned committees/tasks.
  • Assist Pharmacy Director with oversight of clinical and operational programs provided by PBM and other pharmacy vendors.

What you’ll bring:

  • Bachelor’s degree in Pharmacy
    • Doctor of Pharmacy (PharmD) preferred.
  • Requires a minimum of 5 years of experience in pharmacy. Prior Managed Care or Pharmacy Benefit Manager (PBM) experience preferred.
  • Maryland Pharmacy license.
  • Comprehensive understanding of managed care, concepts and principles, and the application of specific JHHP benefit plans highly preferred.
  • 3+ years management experience.

Who we are:

Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine. JHHP is a $3B business serving over 500,000 active members with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHP is a leader in provider-sponsored health plans and is poised for future growth.

Many organizations talk about transforming the future of healthcare, at Johns Hopkins Health Plans, we are setting the pace for change within the healthcare industry. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for our members and the communities we serve.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.

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