Pharmacy Services Director

1 day ago

Salt Lake, Utah, United States Intermountain Health Full time
Job Summary

The Pharmacy Services Manager provides strategic leadership and direction to SelectHealth Pharmacy Services and SelectHealth Prescriptions. This role contributes to the clinical and operational direction of the department, identifying opportunities for cost-effective quality pharmacy benefits to members.

Key Responsibilities
  • Analyze pharmacy claims to identify areas of utilization aberrations and opportunities for cost-efficiencies.
  • Manage the clinical administration of Pharmacy Services, including formulary, academic detailing/education, and the residency program.
  • Oversee the Pharmacy & Therapeutics (P&T) Newsletter and other communications to providers and pharmacies.
  • 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.
  • Ensure coordination and communication of PBM programs with standalone PBM clients and geographic expansion partners.
  • Maintain positive partnerships and relations with contracted retail pharmacies and pharmaceutical companies.
  • Coordinate, manage, and monitor pharmacy claims processing services, utilization management, and prior authorization protocols.
  • Participate in, and work with, corporate drug manufacturers to obtain rebates, price discounts, and disease management plans, or other cost reductions.
  • Aid in contracting and auditing the SelectHealth Pharmacy Network.
  • Coordinate clinical pharmacy programs with the different Intermountain Clinical Programs.
  • Conduct Drug Utilization Review projects as appropriate, which includes the ability to query and analyze pharmacy data.
  • Coordinate and oversee Pharmacy Resident Program and student rotations.
  • Coordinate the appropriate use of specialty medications, including contractual arrangements and claims adjudication.
  • Promote stand-alone PBM through relationships with brokers and key employer group executives.
  • Support the education and promotion of pharmacy services to both internal and external customers.
  • Responsible for the administration of all medication therapy management programs for Medicare Part D, Medicaid, Commercial lines of business, and medical homes.
  • Provides direct support and direction for the management of Medicaid pharmacy services and the Medicaid Restriction program to ensure maximal cost-effective benefit administration.
  • 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.
Requirements
  • PharmD degree or Master's degree from an accredited school of pharmacy.
  • State license to practice pharmacy and dispense controlled substances.
  • Five years of pharmacy practice experience in a managed care and hospital environment.
  • Five years of Pharmacy Benefits management experience.
Preferred Qualifications
  • Advanced degree in business management or healthcare administration.
  • Pharmacy experience in a managed care setting, including an ASHP accredited managed care residency.
  • Strong healthcare systems orientation, including managed care, retail, and hospital pharmacy, pharmacy contracting, pharmaceutical company contracting.
  • Strong verbal and written communication skills.
  • Personal computer skills, including word processing and spreadsheets.
  • Detail-oriented, data analysis, and manipulation skills, Microsoft Office proficiency, able to analyze, formulate recommendations, and summarize those recommendations, comfortable presenting.
  • Ability to evaluate drug formularies and find opportunities for optimization. Ability to interpret contract language and apply it to practice.

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