Director, Pharmacy
2 months ago
When you become part of the CareNu Team, you'll realize it's more than a job. It's a mission. We're committed to providing groundbreaking solutions for our clients' unique needs offering a wide variety of compassionate healthcare choices. Our employees make all the difference in our success
The Pharmacy Director is responsible for the management and oversight of the PART D benefits for the health plan and the population health risk bearing business lines. Will potentially be responsible for assigned staff in the future.
**This is a hybrid role that requires 3-4 days in the corporate office/week**
Qualifications:
- PharmD or BPharm/RPH required.
- Two or more years of managed care experience or completion of a managed care residency. Applicable specialty pharmacy experience also considered.
- Industry experience with pharmacy and medical claims adjudication, NCPDP standards, Part D Medication Therapy Management (MTM) requirements, NCQA, HEDIS, pharmacy benefit design, formulary management, provider networks and performance management, prior authorization management, drug utilization review, customer service, and PBM clinical oversight.
- Strong understanding and ability to interpret Medicare regulations and guidance.
- High degree of technological aptitude required.
- Strong internal relationship building skills required.
- Strong external relationship skills required with the PBM, contracted pharmacies/providers and other delegates.
Job Responsibilities:
- Manage the oversight and monitoring of SECUR's prescription drug benefits and Part D program.
- Managing and/or supporting the clinical pharmacy functions of the SECUR's Part D department.
- Provide optimal clinical and pharmaceutical care activities in accordance with the department's mission, vision, and goals.
- Promote and manage drug therapy management programs based on current clinical knowledge, industry trends and regulatory requirements.
- Assist in achieving goals related to utilization management, clinical and quality management programs, patient safety measures, fraud waste and abuse, regulatory compliance, and serving as a liaison between our members and their providers and pharmacies.
- Be responsible for:
- All Part D-related regulatory reporting requirements and ensure all are met within mandated timeframes.
- Population Health: Analyze, monitor, and evaluate population health data to identify and assess the impact of utilization trends and provide clinical decision support for areas of improvement for Part D drugs across all markets. This includes provider and member education, serving as a provider prescribing resource, and collaboration healthcare providers and group practices to ensure clinically appropriate and cost-effective medication utilization with SECUR's aligned goals.
- Clinical Programs: Maintain competency in clinical practice including appropriate drug therapy for patients and prevention/resolution of drug related problems. Responsible for drug related reviews and evaluate clinical guidelines and Drug Utilization Reviews (DUR), provides consultations, operationalizes clinical programs including but not limited to overutilization management system and patient safety, prepares processes and conducts research when applicable.
- PBM Clinical Oversight: Perform clinical oversight of our PBM's delegated functions such as Formulary Administration, P&T Committee decisions, Coverage Determinations, Transition Policy and Drug Management Programs. Provide oversight and monitoring of delegated programs to our PBM and collaborate successfully in driving quality, safety, and cost-saving initiatives.
- Compliance of Part D Operations: Adhere and assist in maintenance of policies and procedures as well as standard operating procedures and knowledge base documents to ensure compliance with Medicare and the State of Florida requirements. Coordinate with internal and external stakeholders on annual and quarterly reporting to CMS. Responsible for SECUR's required actions related to CMS communications and regulatory changes, clinical operations and oversight of prescription dispensing, and reporting on key performance indicators (KPIs). Operationalize statutory programs, including Drug Management Programs and Part D FWA monitoring and reporting.
Competencies:
- Satisfactorily complete competency requirements for this position.
Responsibilities of all employees:
- Represent the Company professionally at all times through care delivered and/or services provided to all clients.
- Comply with all State, federal and local government regulations, maintaining a strong position against fraud and abuse.
- Comply with Company policies, procedures and standard practices.
- Observe the Company's health, safety and security practices.
- Maintain the confidentiality of patients, families, colleagues and other sensitive situations within the Company.
- Use resources in a fiscally responsible manner.
- Promote the Company through participation in community and professional organizations.
- Participate proactively in improving performance at the organizational, departmental and individual levels.
- Improve own professional knowledge and skill level.
- Advanced electronic media skills.
- Support Company research and educational activities.
- Share expertise with co-workers both formally and informally.
- Participate in Quality Assessment and Performance Improvement activities as appropriate for the position.
Leadership Success Factors:
- Communication. Express thoughts and ideas clearly. Adapt communication style to fit audience.
- Initiative. Originate action to achieve goals.
- Management Identification. Identify with and accept the problems and responsibilities of management.
- Judgment. Make realistic decisions based on logical assumptions, factual information and in consideration of organizational resources.
- Planning, Organizing and Controlling. Establish course of action for self and/or others to accomplish a specific goal; plan proper assignments of personnel and appropriate allocation of resources. Monitor results.
- Leadership. Use appropriate interpersonal styles and methods in guiding others.
- Ethics. Model highest standards of conduct and ethical behavior, adopting a strong position against fraud and abuse.
- Regulatory Compliance: Educate and monitor staff regarding their own and the Organization's responsibilities for regulatory compliance.
This position requires consent to drug and/or alcohol testing after a conditional offer of employment is made, as well as on-going compliance with the Drug-Free Workplace Policy.
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