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.

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

What You Will Do

• 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

About Cambia

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Why Join the Cambia Team?

• Work alongside diverse teams building cutting-edge solutions to transform health care
• Earn a competitive salary and enjoy generous benefits while doing work that changes lives
• Grow your career with a company committed to helping you succeed
• Give back to your community by participating in Cambia-supported outreach programs
• Connect with colleagues who share similar interests and backgrounds through our employee resource groups

Benefits

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits
• Annual employer contribution to a health savings account
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period)
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave)
• Award-winning wellness programs that reward you for participation
• Employee Assistance Fund for those in need
• Commute and parking benefits

Contact Information

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com.