Director, Pharmacy Government Programs

2 weeks ago

Baltimore, United States CareFirst BlueCross BlueShield Full time

**Resp & Qualifications**

**PURPOSE**:
Director, Pharmacy Government Programs is responsible for implementing the organization's pharmacy vision and strategic plan for government programs (Medicare and Medicaid). This role has oversight of pharmacy staff and develops and maintains collaborative relationships with clinical, administrative, and other key stakeholders including external vendors to ensure effective operations and value realization of government pharmacy programs. This role serves as a key point of contact within the organization providing clinical expertise relative to pharmacy benefit programs, participates in designing, developing, and implementing clinical programs to promote cost-effective medication use. This role also serves as a key point of contact with the Maryland Department of Health (MDH) and U.S. Centers for Medicare and Medicaid Services (CMS).

**ESSENTIAL FUNCTIONS**:

- Provides oversight and support for the management of multi-faceted pharmacy government programs to reduce pharmacy spend, total cost of care, improve Star and HEDIS scores, and improve health outcomes, Support programs from evaluation through implementation and value realization. Works with operations for implementation and the Sales and Marketing teams for program education to communicate the value of these programs in the market. Monitors and tracks program activity and performance and communicates outcomes to key stakeholders within the organization.
- Ensures compliance to all regulatory requirements and pharmacy processes are carried out in accordance with MDH, CMS, and other federal and state regulatory bodies. Serves as a chair of several internal committee's including but not limited to Pharmacy &Therapeutics Committee, Quality Improvement Committee, and Vendor Management Committee. Prepares for annual submissions to and responds to other requests from MDH and CMS.
- Manages and directs staff, demonstrating effective performance management of team members and supports activities to maintain a high functioning team. Reviews staffing goals and expectations to ensure that each is consistent and adequate to meet department goals. Provides coaching and motivation to team members ensuring staff has appropriate tools and training. Plans and manages the departmental budget.
- Serves as a point of contact for CareFirsts PBM vendor and other strategic pharmacy vendor partnerships. Ensures vendors execute contract terms. Identifies and implements vendor programs based on CareFirsts needs such as quality initiatives, compliance, population health, and/or member/provider experience.
- Analyzes Medicare and Medicaid pharmacy and medical drug utilization data to identify trends and at-risk populations; recommend and develop appropriate interventions; monitors and takes actions on results. Identifies business process improvements that are aligned with and supportive of business goals and objectives. Contributes to the development of dashboards that monitor critical data elements and tracks results for Executive Leaders. Identifies actional insights based on data and helps to ensure successful implementation of clinical savings.
- Develops, provides, and oversees formal written and verbal presentations and other communications related to clinical pharmacy programs, Able to effectively present pharmacy information to key internal and external stakeholders at an Executive Level.

**SUPERVISORY RESPONSIBILITY**:
This position manages people.

**QUALIFICATIONS**:
**Education Level**:PharmD in Pharmacy.

**Licenses/Certifications Upon Hire Required**:

- PHARMD - Licensed Pharmacist

**Experience**:

- 8 years experience working in the healthcare industry with a focus on a pharmacy benefit administration.
- 3 years management experience.

**Preferred Qualifications**:

- Active Pharmacist license in Maryland, or the ability to obtain Maryland licensure within 6 months of employment.
- Minimum two years involvement in formulary development, drug use evaluation, and quality improvement activities.
- Experience with developing and implementing clinical programs.
- Experience with Medicare Part D and Medicaid guidelines and requirements.
- Completion of a pharmacy practice or specialty residency (PGY1 or PGY2).

**Knowledge, Skills and Abilities (KSAs)**
- Entrepreneurial, highly motivated, and collaborative
- Ability to establish credibility and influence persons of all levels and member executive management and lead them to the proper decisions.
- Demonstrated track record of building strong relationships, working collaboratively and driving consensus.
- Ability to identify diverse needs of member constituencies and develop effective solutions.
- Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external cu

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