Director, Pharmacy Quality Improvement

4 weeks ago

WEST PALM BEACH, United States Centene Pharmacy Services Full time

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: Oversees the operation of initiatives and programs focused on improvement in pharmacy quality measures (Part D Patient Safety Measures, HEDIS, PQA, etc.), and drug utilization review. Drives the strategic planning, implementation, financial oversight and evaluation for these business units. In addition, provides daily oversight of all operations by working closely with external vendors, manager(s), clinical pharmacist(s), and other support staff. High priority is placed on seeking opportunities for improvement or innovation through industry intelligence gathering and competitive analysis. Builds a strong team and drives team performance. Candidate Education: Required A Bachelor's Degree in Pharmacy
  • Provides strategic leadership by building strong teams and driving performance.
  • Ownership of financial and operational objectives for pharmacy quality initiatives and retrospective drug utilization programs through budget creation, maintenance and execution.
  • Develops, plans and implements all clinical initiatives through collaboration with cross functional teams. Functions as a project manager in execution of launch plan and implementation of systems and procedures.
  • Drives the selection of vendors and suppliers for assessment and provides recommendations for partnerships.
  • Develops and oversees communication and contracts with preferred vendor representatives to execute contract provisions for effective clinical programs aimed to improve quality and drug utilization
  • Develops financial and operational metrics to track business performance and identifies operational improvement opportunities
  • Ensures pharmacy department meets all regulatory compliance requirements relating to functions performed across multiple business units. Includes submission of CMS reports and state regulatory reports across all lines of business.
  • Conducts market research and proposes business growth initiatives through strategic planning.
  • Manages and develops direct reports. Sets direction, allocates and re-allocates resources as required.
  • Oversees improvement in Part D Safety Measures Star scores, HEDIS and others as assigned giving great attention to and ensuring achievement in these measurements by:
  • - oversight of multiple vendors
  • - industry intelligence / competitive analysis
  • - participation in PQA work groups and advisory panel
  • Manages corporate QI Trilogy documents for Medicaid / Medicare and UMAC/QIC across entire pharmacy organization for all lines of business; Owns PDP QI structure
  • Manages multiple corporate committees (ie Pharmacy Quality Oversight, Quality Improvement Work group, Drug Utilization Review)
  • Performs special duties as needed.
Preferred A Doctor of Pharmacy (PharmD):
Preferred A Master's Degree in BusinessCandidate Experience: Required 7+ years of experience in a licensed pharmacist role, OR completion of PGY-1 residency program + 5 additional years licensed pharmacist upon completion

Required 4+ years of experience in Managed Care/Pharmacy Star Ratings/Quality Metrics:
Required Other 3 years managing / leading others Licenses and Certifications: A license in one of the following is required: Required Registered Pharmacist (RPh)
Required Other licensed pharmacist in state of operationPay Range: $142,300.00 - $263,500.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

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