PHARMACY DIRECTOR, Medicare Advantage Health Plan

5 days ago


Charleston, United States The French Group Full time

We are seeking a highly skilled and motivated individual to join our team as the Director of Pharmacy. This leadership role provides strategic, tactical, and operational leadership in creating evidence-based pharmacy care programs instilling and reinforcing our mission and advancing the role of a health plan in providing the right care. JOB RESPONSIBILITIES Clinical Pharmacy Program Development: As the Director, you will be responsible for designing, implementing, managing, and measuring the development of comprehensive clinical pharmacy programs. This includes focusing on optimizing medication management, ensuring appropriate and effective medication utilization, and improving health outcomes for our members. Multi-Disciplinary Collaboration: You will actively engage as a leader for the I-SNP (Institutional Special Needs Plan) and collaborate with physicians, nurse practitioners, care managers, and behavioral therapists to ensure a patient-centered approach to medication management. Your expertise will contribute to enhancing overall care coordination and treatment outcomes. Team Management: You will lead and mentor a team of clinical pharmacists. Your guidance will be vital in fostering a collaborative and innovative environment to achieve program objectives. Utilization Management: Collaborate with cross-functional teams to identify utilization trends and lead specific interventions to manage medical and pharmacy drug utilization and ensure cost-effective and evidence-based medication practices. Your expertise will contribute to maintaining the highest quality of care while managing expenses. Stars Performance: Enhance stars performance related to medication adherence and pharmacy measures. Compliance and Regulatory Oversight: Maintain a thorough understanding of Medicare Advantage regulations, guidelines, and standards related to pharmacy services. Ensure that all clinical pharmacy program activities are compliant with regulatory requirements. Data Analysis and Reporting: Utilize data analytics to evaluate the effectiveness of the clinical pharmacy program and identify areas for improvement. Regularly report on program outcomes and collaborate with stakeholders to optimize results. Stakeholder Collaboration: Foster positive relationships with internal and external stakeholders, including providers, healthcare partners, and pharmacy benefit managers. Collaborate to enhance patient care and overall health plan performance. Continuous Improvement: Promote a culture of continuous improvement and innovation within the clinical pharmacy department. Stay current with industry trends and best practices to maintain the organization’s competitive edge. QUALIFICATIONS/EXPERIENCE REQUIREMENTS Doctor of Pharmacy (PharmD) degree from an accredited institution required. Minimum 4 years of experience in clinical pharmacy leadership roles, preferably within a Medicare Advantage Plan/ISNP. Strong understanding of Medicare Advantage regulations and pharmacy-related quality measures (Stars ratings). Proven track record of developing and implementing successful clinical pharmacy programs. Excellent leadership, communication, and interpersonal skills. Proficiency in data analysis and reporting tools. Ability to adapt to a fast-paced and dynamic healthcare environment. #J-18808-Ljbffr



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