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. Position can be remote with some time required in office. Will involve some travel.

Provides direct management to pharmacy clinical coordinators, multiple pharmacy residents, and the business development consultant.

Key Responsibilities:
  1. Analyzes pharmacy claims to identify areas of utilization aberrations and opportunities for cost-efficiencies.
  2. Manages the clinical administration of Pharmacy Services, including formulary, academic detailing/education, and the residency program.
  3. Oversees the Pharmacy & Therapeutics (P&T) Newsletter and other communications to providers and pharmacies.
  4. Ensures 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. Ensures coordination and communication of PBM programs with standalone PBM clients and geographic expansion partners.
  6. Maintains positive partnerships and relations with contracted retail pharmacies and pharmaceutical companies.
  7. Coordinates, manages, and monitors pharmacy claims processing services, utilization management, and prior authorization protocols.
  8. Participates in, and works with, corporate drug manufacturers to obtain rebates, price discounts, and disease management plans, or other cost reductions.
  9. Aids in contracting and auditing the SelectHealth Pharmacy Network.
  10. Coordinates clinical pharmacy programs with the different Intermountain Clinical Programs.
  11. Conducts Drug Utilization Review projects as appropriate, which includes the ability to query and analyze pharmacy data.
  12. Coordinates and oversees Pharmacy Resident Program and student rotations.
  13. Coordinates the appropriate use of specialty medications, including contractual arrangements and claims adjudication.
  14. Promotes standalone PBM through relationships with brokers and key employer group executives.
  15. Supports the education and promotion of pharmacy services to both internal and external customers.
  16. Responsible for the administration of all medication therapy management programs for Medicare Part D, Medicaid, Commercial lines of business, and medical homes.
  17. Provides direct support and direction for the management of Medicaid pharmacy services and the Medicaid Restriction program to assure maximal cost-effective benefit administration.
  18. Responsible for the creation and maintenance of 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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