Director, Pharmacy

Support the AVP of Medical Cost Containment in implementing, improving, and optimizing clinical programs with a focus on pharmacy and associated operational processes. Drive analytic measurement and enhancement of medical management for assigned programs, achieving outcomes through analytics, clinical operations, and new program development to align with organizational vision and cost savings.

Responsibilities

• Serve as a business owner for medical product management needs specific to pharmacy programs, establishing key performance indicators, identifying opportunities, and driving business goals.
• Manage a remote team of 8 pharmacists overseeing a nationwide prior authorization program for workers compensation claims.
• Monitor, analyze, and trend clinical program data to assist in developing, implementing, and driving key initiatives.
• Evaluate new and emerging regulations impacting the program and problem-solve to implement changes and produce outcomes.
• Optimize clinical programs for nurse and adjuster efficiency, streamlined injured employee experience, and positive claim outcomes.
• Manage day-to-day issues with clinical program management, interfacing with vendors and internal staff.
• Identify best practices and trends in the industry; evaluate new and emerging technologies and treatments for potential program incorporation.
• Participate in office-managed care and clinical operational reviews.
• Manage project development and enhancements through coordination with workers compensation operations.
• Stay current with market trends and demands.
• Perform other functionally related duties as assigned.

Requirements

• PharmD or RPH.
• Experience with Workers Compensation insurance carrier setting or related industry.
• Ability to lead a team of pharmacists and drive process improvement efforts to enhance organizational outcomes.
• Demonstrated results in developing strategic plans and executing key initiatives.
• Proficient in data evaluation and visualizations.
• Excellent English communication skills, both written and verbal, with strong analytic, documentation, and organizational abilities.
• Efficient in multitasking between projects.
• Proficiency in Microsoft Office products including Project, Word, Excel, PowerPoint, Visio, and SharePoint.
• Ability to prepare and effectively communicate presentations, interpret/develop reports, metrics, and improvement plans.
• Collaborate effectively with multi-functional teams and foster an environment of shared responsibility and accountability.

Preferred Qualifications

• 2+ years of managing projects and/or vendor relationships.
• 2+ years of experience writing SQL queries, creating stored procedures, views, and functions.
• 2+ years of management experience.
• Project Management Office (PMO) experience.
• Knowledge of workers' compensation laws and regulations, medical billing (ICD9/10, CPT, HCPCS).
• Experience with State and external accreditation managed care audits.
• Experience writing and implementing program-level policies and procedures.

Pay

The expected salary range for this role is $130,000–$155,000. Salaries are based on factors including candidate skills, experience, education, training, scope and responsibilities of the role, and market and business considerations.

Benefits

• Medical & Dental Plans
• Life Insurance (including eligible spouses & children)
• Health Care Flexible Spending
• Dependent Care
• 401k Savings Plans
• Paid Time Off

AmTrust values diversity and inclusion, embracing differences in race, ethnicity, gender, sexual orientation, culture, religion, and disabilities to sustain a competitive advantage and attract, retain, and develop top talent.