Pharmacy Services Director

4 weeks ago


Davis, Oklahoma, United States Intermountain Health Full time
Job Description:

The Pharmacy Services Manager provides strategic leadership and direction to SelectHealth Pharmacy Services and SelectHealth Prescriptions. This position contributes to the clinical and strategic direction of the department, identifying and promoting changes to provide cost-effective quality pharmacy benefits to members.

Schedule and Scope:

Regular business hours 8-5, with some remote work and travel required. The Manager oversees direct management of pharmacy clinical coordinators, multiple pharmacy residents, and the business development consultant.

Key Responsibilities:
  1. Analyze pharmacy claims to identify areas of utilization aberrations and opportunities for cost-efficiencies.
  2. Manage the clinical administration of Pharmacy Services, including formulary, academic detailing/education, and the residency program.
  3. Oversee the Pharmacy & Therapeutics (P&T) Newsletter and other communications to providers and pharmacies.
  4. Ensure coordination and communication of pharmacy benefit management (PBM) programs, including drug manufacturer contracting, P&T Committee activities, physician communication/education, retail/community pharmacy, NCQA qualification, information services, clinical intervention programs, drug usage evaluation programs, and pharmacy outcomes research.
  5. Coordinate and communicate PBM programs with standalone PBM clients and geographic expansion partners.
  6. Maintain positive partnerships and relations with contracted retail pharmacies and pharmaceutical companies.
  7. Coordinate, manage, and monitor pharmacy claims processing services, utilization management, and prior authorization protocols.
  8. Participate in and work with corporate drug manufacturers to obtain rebates, price discounts, and disease management plans, or other cost reductions.
  9. Aid in contracting and auditing the SelectHealth Pharmacy Network.
  10. Coordinate clinical pharmacy programs with Intermountain Clinical Programs.
  11. Conduct Drug Utilization Review projects as appropriate, including the ability to query and analyze pharmacy data.
  12. Coordinate and oversee the Pharmacy Resident Program and student rotations.
  13. Coordinate the appropriate use of specialty medications, including contractual arrangements and claims adjudication.
  14. Promote standalone PBM through relationships with brokers and key employer group executives.
  15. Support the education and promotion of pharmacy services to internal and external customers.
  16. Administer all medication therapy management programs for Medicare Part D, Medicaid, Commercial lines of business, and medical homes.
  17. Provide direct support and direction for the management of Medicaid pharmacy services and the Medicaid Restriction program to ensure maximal cost-effective benefit administration.
  18. Responsible for creating and maintaining the SelectHealth medication fee schedules, including the MAC list for pricing of generic drugs, J-code fee schedules for use in physician offices, retail pharmacies, specialty pharmacies, home health, and infusion centers.


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