Manager Clinical Pharmacy Quality and Affordability Programs

About the role

Hybrid role (3 days/week in office) at our Burlington, Renton, Spokane, Vancouver, Portland, Medford, Salt Lake City, Boise, Lewiston, Fargo offices. Candidates must reside within commutable distance of that location or be willing to relocate.

Responsibilities

• Prioritizes and manages the implementation, and maintenance of clinical pharmacy programs, including (but not limited to) Stars, HEDIS, eValu8, and other clinical safety, quality, and affordability programs which encourages the use of the best value medications, discourage use of unsafe medications or those with limited clinical value.
• Leads, and collaborate with, departmental and cross-organizational teams and committees (including clinical services, customer services, product, sales, marketing, operations, medical management, contracting/rebates, analytics) and with external vendors.
• Assures service levels and activities meet client service level agreements, as well as contractual obligations and compliance, such as state, federal, and CMS regulations or specific member contracts, with service guarantees.
• Provides routine and/or intermittent reporting and analysis as appropriate of clinical program activities that fall under their oversight.
• Ensures continuous quality assurance inclusive of documented policies, procedures, and workflows for all programs.
• Provides leadership and mentorship to direct reports, including clinical and non-clinical staff, through development and tracking of performance goals and objectives, as well as through quarterly performance conversations.
• Prioritizes and manages work activities of clinical pharmacist consultant staff.
• Collaborates with the Pharmacy Directors, VPs, and other leadership in coordinating corporate-wide activities related to the appropriate use of medications, improved quality related to medication therapy, promotion of cost-effective prescribing, and reduction in short-term and long-term overall costs to internal and external clients.
• Handles all management level responsibilities for staff, hiring, firing, coaching, counseling, and retention.
• Manages financial targets and department budget, authorizes expenditures, monitors workforce allocation and resources, and oversees project plans.

Qualifications

• Bachelor's degree in Pharmacy or Pharm.D; Residency certificate or advanced degree in health care administration, economics, public health, pharmacy administration, finance, or equivalent field preferred
• Minimum 3 years of experience in patient care setting as well as management or professional business experience in a managed health care system, medical group, hospital, or related business in health care delivery industry or an equivalent combination of education and experience
• Licensed pharmacist in state of practice

Skills and Attributes

• Strong clinical pharmacy background with ability to demonstrate clinical therapy skills and knowledge
• Strong business acumen, knowledge of health care economics and financing, health care and PBM industry dynamics, benefit design, provider contracting strategies, techniques, and operational processes
• Demonstrated success in managing matrixed professional business relationships in a managed care system, medical group, hospital, or related business in health care delivery industry
• Excellent verbal and written communication skills; strong business analytical skills and abilities; project management and coordination ability; ability to function effectively as a management team member
• Demonstrated ability to review and analyze data from medication claims, recommending programs and policies to encourage appropriate utilization
• Ability to select, train and lead staff, manage resources and prioritize workload
• Demonstrated knowledge of: Medicare/CMS regulations and applicability in administering the Medicare Product; Pharmaceutical products, including orals, injectables, infusion products, and chemotherapy; Health care coding and payment systems (such as ICD-10, CPT, HCPCS, NDC); Compliance related activities, legislative and regulatory activities; state and federal laws and rules regarding the practice of pharmacy and regulation of health care industry practices, such as DOLI, PPACA and HIPAA
• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

Benefits

Pay ranges vary based on the candidate's work location. The expected hiring range depends on skills, experience, education, and training; relevant licensure / certifications; and performance history. Details about benefits can be found in the "About Cambia" section of the job posting.