Pharmacy Manager

4 days ago


Orange, California, United States Alta Hospitals Full time
Pharmacy Manager Job Description

At Alta Hospitals, we are seeking a highly skilled Pharmacy Manager to lead our pharmacy referral team and ensure compliance with federal, state, and health plan guidelines. The successful candidate will have a strong background in pharmacy management, excellent communication skills, and the ability to implement operational changes through staff education and interdepartmental collaboration.

Key Responsibilities:
  • Lead the pharmacy referral team to ensure compliance with federal, state, and health plan guidelines
  • Implement and monitor value-based contracts to meet pharmacy cost targets
  • Oversee pharmaceutical rebate submission and monitoring processes, health plan cap deductions, and duplicate claims
  • Manage the pharmacy referral team to ensure compliance with federal/state/health plan/IPA guidelines, educate staff on clinical and administrative updates, and implement utilization management strategies
  • Conduct monthly assessments of pharmacy data by region and for value-based contracts to identify targeted drugs and prescribers to promote evidence-based cost-effective utilization
  • Implement clinical interventions and provide monthly summary reports
  • Oversee and monitor the process of submitting and auditing rebate reports, health plan cap deduction files, duplicate claims reports, and MTM payments
  • Dispute inappropriate cap deducted claims with health plans by coordinating with all internal stakeholders
  • Lead ongoing interdepartmental meetings for cap deductions
  • Provide assistance and participate in state and health plan audits
  • Assess staffing bandwidth to ensure compliance with turn-around-time and other UM-related requirements
  • Provide support for member appeals and grievances
  • Review leakage reports for capitated specialist groups
  • Process daily referrals and complete ad hoc projects
Requirements:
  • Active pharmacist license for CA, AZ, and TX
  • Management experience
  • Prior authorization experience
  • Experience and knowledge for injectables and infusion
  • Health plan pharmacy vs. medical benefits
  • Microsoft Excel, Word, PowerPoint

Location-Based Pay Adjustment


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