Manager, Pharmacy Experience and Access

About SCANSCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, serving more than 270,000 members in California, Arizona, Nevada, Texas and New Mexico. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn, Facebook, and Twitter.The JobThis position will play a central role in designing and executing the Part D program for coverage determinations, appeals, and grievances for a senior-focused Medicare Advantage Plan. The Manager will be responsible for ensuring CMS compliance with regard to operations, star rating performance, and enhanced member/provider experience. The Manager will also provide leadership support and direction to the team, ensuring appropriate oversight of the contracted pharmacy benefit manager (PBM).You WillLead and supervise the Pharmacy Experience & Access team to oversee and optimize PBM delegated programs for compliance and effectiveness (i.e., concurrent DUR, retroDUR, FWA, Patient Safety Analysis, Opioids) and collaborate with PBM on program enhancements or CMS requirements.Ensure operations of the coverage determination, appeals, and grievances (CDAG) are effective, compliant, timely and prevent the occurrences of ICARs, CMPs or CMS data accuracy issues that negatively impact the plan.Leverage clinical data, social determinants of health, analytics and technology to enhance members' pharmacy care experience, throughout CDAG, DUR, and pharmacy care management programs.Support Sr. Director of Pharmacy Quality Care & Experience and department with preparations for speaking engagements, meetings, publications etc.Support Sr. Director of Pharmacy Quality Care & Experience and participate in innovation brainstorming and initial ideation on new initiatives.Through routine tracking and trending, determine and implement process enhancements that strengthen compliance, efficiency and member experience. Oversee quality improvement and process enhancement projects internally and with contracted PBM.Serve as a subject matter expert for Part D coverage determinations, redeterminations, grievances and Part C organization determinations as needed.Oversee issues and monitor results staff activities, keeping upper management informed of issues and solutions under consideration.Maintain a strong report with PBM representatives such that department goals and needs are met.Ensure unit effectively oversees PBM delegated operations and reporting to ensure efficient processes and compliance. Oversee PBM operations to ensure high service level to SCAN and our members.Lead monitoring and auditing efforts and ensure ongoing audit preparedness.Develop and maintain strong relations with internal departments (ex. GAD, Member Services, HCS, Compliance etc.) and contracted PBM.Ensure consistent and strong star performance for areas of responsibility and subject matter expert for the organization.Serve as pharmacy expert on a variety of committees and workgroups as required. Collaborate and educate as needed with Member Services such that upstream processes for Pharmacy Quality Care & Experience are compliant.Instill a culture of continuous process improvement, efficiency, collaboration, operational excellence and compliance amongst team.Provide guidance, supervision, development and coaching to a team of clinical pharmacists, technicians & support personnel.Ensure detailed policies and procedures and standard operating procedures for clinical operations remain relevant and up-to-date. Manage internal adherence to these policies and procedures.Accomplish staff results by communicating job expectations; planning, monitoring, and appraising job results; coaching and counseling employees; initiating, coordinating, and enforcing systems, policies, and procedures.Supervise/manage approximately 5-9 employees.Maintain staff by recruiting, selecting, orienting, and training employees; maintaining a safe and secure work environment; and developing personal growth opportunities.Maintain current knowledge of relevant Medicare Part D regulations by participating in CMS calls and reading released guidance and implementing changes/updates to maintain compliance.Ensure detailed policies and procedures and standard operating procedures for operations.Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.Contribute to team effort by accomplishing related results as needed.Your QualificationsRequired: Pharm.D. or equivalent degree from an accredited school of pharmacy in the USA.Preferred, if applicable: Completion of a PGY1 and/or PGY2 residency or equivalent clinical practice experience.Current & Active Pharmacist Licensure in any state required.Residency in clinical pharmacy practice preferred.5+ years or more of managed care pharmacy experience; or equivalent experience in a managed care setting, strongly preferred.1-2 years leadership/management experience, strongly preferred.Demonstrated knowledge of Medicare Part D regulations required.Pharmaceutical and medical knowledge necessary to effectively discuss drug therapy issues with healthcare providers and members.Strong communication including verbal, written, and interpersonal skills.Strong leadership, supervisory, and accountability skills.Strong analytical, problem-solving, decision-making skills.Strong organizational, time management, and project management skills.Strong customer service orientation and commitment to professionalism is required.Ability to work cross-functionally and collaboratively across the organization.Ability to think strategically and act tactically.Self-starter, innovative, and resourceful.Demonstrated ability to effectively multi-task to manage multiple priorities at once.Detail-oriented and ability to work in a fast-paced, ever changing work environment.Working knowledge of applicable state and federal pharmacy regulations preferred.Ability to teach and serve as preceptor for training programs.Ability to keep up-to-date on regulatory requirements through extensive reading, required.Possess computer skills necessary to perform job functions.Knowledge and experience with organizing quality improvement initiatives and presenting findings to leadership preferred.Previous experience in precepting and mentoring pharmacy students and residents is desirable/preferred.What's in it for you?Base salary range: $147,900to$236,600per yearMostly Onsite Work ModeInternal title: Manager, PharmacyAn annual employee bonus programRobust Wellness ProgramGenerous paid-time-off (PTO)Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holidayExcellent 401(k) Retirement Saving Plan with employer match and contributionRobust employee recognition programTuition reimbursementAn opportunity to become part of a team that makes a difference to our members and our community every dayWe're always looking for talented people to join our team Qualified applicants are encouraged to apply nowAt SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.#LI-CS2#LI-HybridEqual Opportunity Employer/Protected Veterans/Individuals with DisabilitiesThe contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)