Pharmacy Benefits Program Director; Mount Sinai Health System; Full Time; Days

About the role

The Pharmacy Benefits Program Director is responsible for providing service support, reporting, pricing, and other performance guarantees while working with multiple internal stakeholders and external vendors. This role serves as the primary pharmacy benefits subject matter expert supporting the Mount Sinai Health System.

Responsibilities

• Work with internal stakeholders to maintain the commercial formulary change process, evaluating pharmacy and medical drug strategy opportunities and formulary product enhancements to drive pharmacy affordability to Mount Sinai Health System.
• Responsible for the development of complex utilization management strategies and drug utilization review programs to enhance formulary strategies and improve clinical outcomes in alignment with the clinical determination of the Pharmacy and Therapeutics Committee.
• Ensures the clinical integrity of the Health Plan pharmacy offering.
• Partners with Health Plan Supply Chain to evaluate and deploy available service solutions that meet Health Plan clinical and affordability goals.
• Develops differentiated prescription drug benefit affordability capabilities that meet the unique needs of the buying groups and funding types within the Health Plan book of business.
• Responsible for ensuring downstream implementation processes are efficient and support the continuous development of business strategies.
• Ensures regulatory compliance by reviewing new state mandates and updating internal processes to support adherence.
• Provides clinical and contextual insights to partners within the Health Plan finance, underwriting, and risk-bearing products to ensure that emerging therapeutics and revisions to the US drug supply are accurately reflected in financial projections (trend, underwriting, and pricing).
• Supports and promotes appropriate team alignment and process improvement work.
• Provides coaching and development to teams, in particular, direct reports for succession planning and overall career growth.
• Participate in meetings and presentations to review benefits management performance.
• Collaborate with Mount Sinai Health System Payer Contracting leadership with contracting proposals and growing existing relationships.
• Gather and share relevant competitive intelligence to promote clinical programs and savings strategies.
• Remain abreast of clinical pharmacy practice guidelines, including drug pipelines, bio-similars, gene therapies, and patent expirations, etc.
• Facilitate meetings with PBM to resolve customer service issues and act as the escalated issue contact for pharmacy matters.
• Support detailed ad hoc analysis of pharmacy claims utilization in order to provide clients with consultation and manage follow up questions as they arise.
• Educate and consistently advance the knowledge of pharmacy within Mount Sinai Health System and champion the understanding of clinical integration points across benefits.
• Foster an effective work environment and ensure employees receive appropriate communication, recognition and development.

Qualifications

• Registered Pharmacist required with active licensure in a US state or territory; advanced degree a plus.
• Previous experience in developing clinical programs related to Formulary and Utilization management required.
• Minimum of 6 years experience in the healthcare industry, with focus on Pharmacy Health Plan or Pharmacy Benefit Management.
• Proven capabilities in strategic planning and large-scale project management.
• Demonstrated ability to think/act strategically from a program value perspective and influence key leaders and matrix partners.
• Demonstrated ability to work in a highly matrixed environment.
• Strong communication and facilitation skills with all levels of the organization, including ability to resolve issues and build consensus among groups of diverse internal/external stakeholders.
• Experience with consultative client management methodologies.
• A self-motivated individual displaying ownership, accountability, and responsibility.
• Ability to work through organizational processes needed to support clients.
• Operational understanding and competence with PBM business models.
• Understanding of the financial and pricing strategies of PBM?s.
• Technical skills using all Microsoft programs.

Compensation

The salary range for the role is $153723 - $230584 Annually. Actual salaries depend on a variety of factors, including experience, education, and operational need.