Pharmacy Director

Remote within the United States. For roles that are 100% remote, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required.

About the Role

The Pharmacy Director will serve as the market pharmacy subject matter expert, collaborating daily with internal departments and the PBM while managing requests from State regulators. As a key member of the plan’s management team, this role will oversee the clinical and operational aspects of the pharmacy benefit, with a focus on improving outcomes and providing cost-effective care for Long-Term Services and Supports (LTSS) members enrolled in the Pennsylvania Community HealthChoices (CHC) program.

Responsibilities

• Monitor systems and programs for maximum effectiveness, efficiency, and return on investment.
• Develop and implement, in collaboration with the PBM, new process improvements and programs; analyze and evaluate ongoing effectiveness; identify and implement enhancements, including:
  • PBM oversight (benefit configuration, claims adjudication accuracy, formulary compliance, SLAs, annual review of P&P and reference guides).
  • Ensuring compliance with all applicable state requirements.
• Provide plan-specific Pharmacy SME support as needed by local plan and/or corporate projects.
• Partner with and/or direct PBM in developing innovative programmatic solutions to improve medication adherence and compliance; collaborate with corporate partners to implement these programs across all applicable lines of business.
• Review clinical/financial recommendations and strategies provided by the PBM’s clinical pharmacists to determine feasibility and appropriateness; ensure flawless implementation and monitor results.
• Monitor pharmacy trends; recommend process, product, and program improvements; plan, implement, and monitor changes.
• Review pharmacy utilization reports generated by PBM, in coordination with the PBM clinical team, to improve quality and contain costs.
• Support medical management goals by implementing all pharmacy-related clinical programs and initiatives.
• Work with PBM to identify and resolve operational issues.
• Provide support and attend all pharmacy-related meetings and committees; participate on the Enterprise P&T Committee.
• Generate necessary provider and member communications related to the pharmacy program.
• Stay abreast of industry trends and regulatory changes in the pharmacy industry; evaluate their effect on pharmacy contracts and services.
• Provide on-site education and training for Providers on formulary and pharmacy procedures.
• Develop strategies, with PBM partners, to improve HEDIS ratings and other quality measures.
• Ensure compliance with NCQA accreditation standards.
• Participate in on-site visits to hospital systems, physician group practices, and pharmacies.
• Act as the main point of contact for physicians and plan staff experiencing problems with the pharmacy program (decision, process, timeliness, etc.).
• Act as the main point of contact for the State Agency and respond to all pharmacy inquiries in a timely manner.
• Support the Fraud and Abuse program system oversight; communicate suspected fraud; recommend actions for Providers outside of guidelines; work with PBM to ensure appropriate outreach.
• Coordinate with the compliance team on key operational and medication management issues identified through plan oversight and PBM monitoring.
• Identify cost containment initiatives specific to the line of business; make recommendations and offer program improvements; coordinate initiatives with PBM.
• Develop relationships with local behavioral health providers, PerformCare staff, and PBM to improve healthcare program delivery.
• Create and support an environment that fosters teamwork, cooperation, respect, and diversity.
• Collaborate with PBM to create opportunities, efficiencies, and value within the Enterprise.
• Supervise and develop pharmacy technicians to support the plan’s needs.
• Perform other job-related duties, as assigned.

Requirements

• Pharm.D. required.
• Registered Pharmacist with a current, active, unrestricted Pharmacist license in Pennsylvania.
• Minimum of three (3) years of Medicaid pharmacy benefits management experience required. Retail/community pharmacy experience alone does not meet the requirements for this position.

Benefits

• Flexible work solutions including remote options and hybrid work schedules.
• Competitive pay.
• Paid Time Off (PTO) including holidays and volunteer events.
• Health insurance coverage for you and your dependents starting on Day 1.
• 401(k) retirement plan.
• Tuition reimbursement.