VP Managed Care Pharmacy Services

Job Duties

• Provide operational and clinical oversight and accountability for all managed care pharmacy services, including human resources, financial planning and ongoing growth and development. This includes but is not limited to formulary management, clinical policy development, utilization management operations and pharmacy benefit configuration.
• Serves as department liaison and program steward across the organization, with outside constituents, and with strategic partners including pharmaceutical industry partners, pharmacy benefit managers (PBM), legislative groups, other health systems, schools of pharmacy, and professional pharmacy organizations.
• Oversee the development, revision, and auditing of applicable policies and operational procedures, compliance with federal and state regulatory requirements (CMS, DHS, etc.) and other standards of practice (NCQA, ACA, etc.).
• Led and chairs system-level initiatives and workgroups upon request from executive and system leadership. Provides direction and guidance for the development and implementation of optimum standards of managed care pharmacy services, pharmacy benefit management services, medication therapy disease management, and medication management processes.
• Develops, communicates, and participates in research to enhance the impact of clinical pharmacy and innovative care delivery models providing optimal customized care for Geisinger’s patients.
• Serves in oversight capacity in the development and implementation of all strategic, tactical, and business plans to the Director, Assistant Directors and medical directors to coordinate pharmaceutical care for members
• Effectively engages senior Health Plan and Clinical Enterprise executives in support of daily pharmacy operations, implementation, and prioritization of initiatives. Serves as Secretary on the Health Plan Pharmacy and Therapeutics Committee.
• Provides both clinical and operational guidance and oversight for the enhancement and development of new or existing managed care pharmacy services and practice models.
• Closely collaborates with the Geisinger Health Plan and our KACO partners on system-wide and multidisciplinary initiatives in support of an effective value-based care practice model. Explores mutually beneficial collaborations outside of system, including those with schools of pharmacy, private funders, and research grantees
• Utilizes financial or benchmarking reports to monitor all revenue and expense impacting activity related to all areas of oversight, proactively acts on this information and reports summary information to the CPO.
• Collaborates with Human Resources on recruitment and retention activities regarding pharmacy staff. Provides oversight and guidance for human resource management including development and disciplinary actions. Collaborates with pharmacy leadership team to ensure that the pharmacy staff utilize their highest skill capacity to facilitate innovations in care delivery across the care continuum for all aspects related to pharmacy services.
• Provides administrative, operational, and clinical oversight and guidance for system-wide pharmacy educational programs and processes including pharmacy residency and student programs, collaborative practice, credentialing and continuing professional development of staff.
• Collaborates with Human Resources on recruitment and retention activities regarding pharmacy staff. Provides oversight and guidance for human resource management including development and disciplinary actions. Collaborates with pharmacy leadership team to ensure that the pharmacy staff utilize their highest skill capacity to facilitate innovations in care delivery across the care continuum for all aspects related to pharmacy services.
• Coordinates and analyzes industry, enterprise and member specific data and intelligence to perform needs assessments and solution development for solutions that integrate care, improve clinical quality, and drive affordability, leveraging enterprise pharmacy assets.
• Develop solutions that align with key pillars, including affordability, access, quality, member experience, integrated healthcare, value-based alignment and health equity.
• Utilizes broad understanding of managed care and PBM knowledge to develop, and/or implement strategies and programs to mitigate cost trend and improve health outcomes. Manage relationship and provide oversight of key vendor partners responsible for any outsourced programs.

About the Role

Responsible for overall strategy, planning, development, implementation, and supervision of Enterprise Pharmacy managed care pharmacy services for all lines of business. Possesses and maintains the oversight of the managed care pharmacy staff and leadership teams, functioning as a leader and facilitator in a team-based environment. Clearly and effectively articulates in a timely fashion the mission, goals, directions, critical issues, and values to the employees who work within the respective area of responsibility. Oversees and coordinates the operational and clinical programs of the Enterprise Pharmacy managed care pharmacy services and, in collaboration with Chief Pharmacy Officer (CPO), sets the strategic vision for Geisinger’s managed care pharmacy pillar.