VP Pharmacy Services

Job Description

PRIMARY DUTIES AND RESPONSIBILITIES

• Provides strategic and operational leadership for the Pharmacy division to achieve organizational goals related to financial performance, sustainability, growth, and pharmaceutical management targets established through the strategic planning and budgeting processes.
• Directs the full scope of pharmacy operations, including formulary management, prior authorizations, formulary exceptions, medication adherence, patient accounting, billing practices, vendor billing oversight, and daily systems operations to ensure efficient, effective, and high-quality service delivery.
• Safeguards Pharmacy division readiness for payer, regulatory, contractual, and accreditation requirements, including preparation for the CMS MA bid process and compliance with all applicable vendor, payer, federal, state, and accreditation standards.
• Establishes and oversees pharmacy performance metrics, data analysis, and quality improvement initiatives to evaluate divisional performance, improve patient care outcomes, strengthen contracted performance, and identify opportunities for operational and strategic process improvement.
• Ensures all pharmacy related policies are clinically sound with EBM criteria and have appropriate UM management activities, such as step therapy, for appropriate fiscal management.
• Promotes alignment of clinical, administrative, and business processes across Pharmacy, Finance, Nursing, Medicine, Population Health, Practice, and other MPHC divisions to support patient-centered care and appropriate prescribing, documentation, coding, reconciliation, and reimbursement practices.
• Manages pharmacy technology, systems optimization, and workforce planning, including technology assessment, software testing and implementation, operational system enhancements, staffing model development, and recruitment planning in partnership with Human Resources.
• Serves as the primary representative and spokesperson for the Pharmacy division, building effective internal and external relationships and advancing high levels of satisfaction among patients, members, providers, and other stakeholders across the continuum of pharmacy services.
• Provides timely guidance regarding pharmacy market trends, legislative and regulatory developments, and consultant deliverables to inform strategic decision-making across the organization.

Position Qualifications

• BS Pharmacy or PharmD required
• PharmD, MBA preferred
• Licensure/certification: Must possess Maine and New Hampshire pharmacy license (or eligible)
• Experience: 10 years' experience including managed care experience (i.e., PBM, HMO, group practice) and retail pharmacy experience (i.e., chain, independent, mail order)
• Experience: Leading complex cross-functional projects and implementations, supporting Medicare bid development, formulary strategy, or pharmacy financial analysis, evaluating pharmacy programs and policies from both clinical and financial perspectives, reviewing financial reports, reconciliations, invoices, and pharmacy trend data
• Knowledge: Strong knowledge of Medicare Part D regulations and the Medicare annual bid process, knowledge of pharmacy benefit design, formulary strategy, PBM operations, and pharmacy claims administration, knowledge of pharmacy financial drivers, trend analysis, forecasting inputs, and invoice reconciliation processes, knowledge of federal and state laws and regulations and applicable accreditation standards, strong understanding of drug pipeline trends and factors affecting pharmacy cost and utilization
• Skills: Excellent oral and written communication skills, excellent interpersonal skills, excellent delegation skills
• Abilities: Ability to be a critical thinker, ability to establish accountability, ability to design work processes around customer needs and expectations, ability to prioritize