Pharmacy Manager

4 days ago


Orange, California, United States Alta Hospitals Full time
Job Summary

Alta Hospitals is 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 leadership skills, and the ability to implement value-based contracts to meet pharmacy cost targets.

Key Responsibilities
  • Compliance and Regulatory Management
    • 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.
  • Pharmacy Operations
    • Manage the pharmacy referral team to ensure efficient and effective operations.
    • Implement operational changes through staff education and interdepartmental collaboration.
  • Clinical Interventions
    • Conduct monthly assessments of pharmacy data by region and for value-based contracts to identify targeted drugs and prescribers.
    • Implement clinical interventions and provide monthly summary reports.
  • Rebate and Audit Management
    • 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.
  • Leadership and Communication
    • 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.
Requirements
  • Active pharmacist license for CA, AZ, and TX.
  • Management experience in a pharmacy setting.
  • Prior authorization experience.
  • Experience and knowledge of injectables and infusion.
  • Health plan pharmacy vs. medical benefits.
  • Excellent written and verbal communication skills.
  • Microsoft Excel, Word, and PowerPoint skills.

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