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Benefits Consultant
4 months ago
Oversees the management of the retail, specialty and medical pharmacy benefits programs. Manages programs with thorough knowledge of applicable legal and regulatory requirements, generating necessary reporting, analysis and administration of pharmacy programs. Provides consultative services to Office of Human Resources (OHR), University stakeholders and committees on any pharmacy related area. Relies on experience and judgment to plan and execute goals. Combines clinical and pharmaceutical experience with health benefit and economic analysis to guide the University in getting the best pharmaceutical benefit with the available resources. This position will work collaboratively with other Health Programs team members on cross-functional teams and will manage multiple projects simultaneously.
Essential Responsibilities
Provides clinical and financial consulting for the Office of Human Resources related to the pharmacy benefit program including strategic evaluation of pharmacy benefit program design, description, financials, operations, and policy.
Oversees clinical and economic issues related to the University's pharmacy program clinical committee including recommendations for the development of the plan's drug formulary, review of utilization management programs, and review of other recommendations made by the PBM or other relevant vendors. Maintains and evaluates information on the lowest net cost for drugs and pharmacy benefits as decisions are made on each medication placed on the formulary.
Monitors the pharmaceutical pipeline to help the University manage launches of new medications taking into account the safety, effectiveness, and cost of medications and preparing for utilization and expenditure management of new medications with special attention to high-cost drugs, drugs that have not yet proven their effectiveness or safety, and drugs that are prone to misuse and abuse.
Facilitates the availability of a strong, clinical faculty member from the College of Pharmacy to assist the Clinical Committee with medication and utilization management recommendations and with decisions that represent current pharmacy practice, best practice medical care and clinical guidelines, and current trends in patient care.
Meets with the plan's specialty pharmacy program vendor to review clinical recommendations and concerns, management of pipeline medications, service delivery approaches, and the costs and terms for payment of specialty medications.
Provides support for meetings with the plan's medical third party administrator and vendor to review and evaluate current and pipeline medications covered as part of the plan's medical benefit. Assists with recommendations on drug coverage and formulary changes and utilization management programs. Supports OHR as it moves to having more control of the medical pharmacy program decisions over time including transparency of pricing, review and management of individual medical benefit drug claims, and rebate management.
Leads the University's Pharmacy Program RFP Committee, in both the development and evaluation of any RFPs for Pharmacy Benefit Program contracts.
Effectively represents the University and OHR within the University and in the broader community in any presentations related to the plan experience. This includes the annual or semi-annual presentations to the Administrative Working Group (AWG) and to the Benefits Advisory Committee (BAC) related to the UPlan's Pharmacy Benefit Program experience as well as industry trends.
Provides recommendations for changes to the pharmacy section of the summary of benefits, as needed and appropriate.
Provides updated pharmacy program data, graphs and charts for OHR presentations to the Board of Regents, professional conferences, or other meetings, as periodically requested.
Works with the pharmacy program vendors to resolve employee issues. This may include coverage exceptions, copay exceptions, and general coverage requirements.
Oversees maintenance and use of data warehouse and avoids duplication of efforts.
REQUIRED QUALIFICATIONS
Doctor of Pharmacy (PharmD) plus at least 1 years of clinical pharmacy practice and pharmacy benefit program contract experience.
Licensed pharmacist in the State of Minnesota or eligible to be licensed in Minnesota.
Strong Microsoft office software skills (especially Word and Excel) and other data base programs
Strong communication skills, with the ability to convey complex concepts to diverse audiences.
Analytical mindset with a focus on problem-solving, root-cause analysis, and decision-making.
Ability to work collaboratively in cross-functional teams and manage multiple projects simultaneously.
Understanding of regulatory requirements and compliance issues related to healthcare and pharmaceutical benefits.
Commitment to continuous learning and staying abreast of developments in healthcare policy, health economics, and pharmaceuticals.
PREFERRED QUALIFICATIONS
Experience in healthcare administration, managed care, or health economics, preferably in a managed care or corporate setting.
Knowledge of healthcare benefit design, including pharmaceutical coverage and formulary management.
Proficiency in data analysis tools and techniques, with experience in healthcare and pharmacy analytics preferred.
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