Director Of Pharmacy Services

Director Of Pharmacy Services

MISSION Our mission is to enhance well-being by connecting individuals with vital health resources through a compassionate workforce that embodies the spirit of neighbors helping neighbors.

VALUES HealthOne is guided by a cultural framework that embodies our values and drives our decisions.

As a company our PURPOSE is to care for people by connecting them to resources that help protect them in health related situations. We fulfill our purpose by filtering our decisions through a PRIORITIES lens of asking, "Is what we are about to do ethical, empathetic, economical, and efficient?". By caring for PEOPLE, we are welcoming, authentic, truthful, consistent and humble. We are continuously looking for ways to improve our PROCESS and how we get things done.

HealthOne seeks individuals with integrity and heart to embody our values. Whether you're starting your career or looking to develop additional skills to reach your full potential, HealthOne provides the means to help you achieve your goals.

JOB PURPOSE The Director of Pharmacy Services is responsible for and manages the overall operations and daily activities of Pharmacy Services. The Director guides the direction of clinical pharmacy initiatives using analytic skills to examine utilization patterns and trends to aid in the development of formulary and utilization management programs. Oversees the drug prior authorization, appeals, medical policy and provider grievance processes for pharmacy services. Acts as the primary point of contact for our Pharmacy Benefit Manager and providers vendor management and oversight of that relationship. Provides leadership to and is accountable for the performance of team members and internal and external strategic relationships. Works cross-functionally to provide insight on clinical and financial impact and to support operational and strategic decision making.

ESSENTIAL JOB DUTIES

• Oversees all clinical aspects of current and future pharmacy benefit programs, ensuring appropriate policies, procedures and resources are in place and aligned with all applicable regulations and requirements
• Responsible for the day-to-day management of the Pharmacy Benefit Manager (PBM) and pharmacy consultants when applicable. This includes ongoing oversight of the PBM to ensure contract compliance and adherence to all agreed upon service level agreements and the accurate application of pharmacy benefits for all HealthOne members.
• Directs the development and implementation of clinical pharmacy services and strategies across pharmacy and medical management teams. This may include but is not limited to HEDIS pharmacy metric success, increasing medication adherence, reviewing complex case management pharmaceutical issues, etc.
• Oversees all aspects of staff and/or any vendor(s) performing case review for the pharmacy care management programs, member appeals, grievances and complaints all within the established time periods
• Owns end-to-end process of designing and realizing the integrated clinical pharmacy vision and strategy including program(s) implementation, outcome monitoring and financial forecasting
• Works as a tactical/strategic partner with the Director of Medical Management on the implementation of integrated clinical pharmacy strategies in order to maximize safety, quality of care, member access and revenue.
• Advises medical management staff of appropriate drug utilization for complex cases
• Assists in formulary creation, clinical criteria development, and utilization management activities, including prior authorization and appeals
• Provides oversight of existing program to improve operational processes, staff efficiency and drive the growth and differentiation of pharmacy care service businesses
• Stays abreast to clinical updates including but not limited to new drug releases and treatment guideline updates necessary to develop and maintain pharmacy programs
• Develops and executes clinical pharmacy program strategies to support business growth, market differentiation and improved clinical outcomes
• Strategically partners across the enterprise to support business priorities, clinical synergies, market differentiation and improved clinical outcomes for members
• Prioritizes new program implementation and existing program enhancements based on opportunity for growth, clinical impact, market strategy and capacity of teams
• Directs the planning, organization, and management of pharmacy services at the system level.
• Directs day-to-day operations for the department; oversees quality assurance, clinical and administrative services, staff development programs, and the development of policies and procedures.
• Develops departmental short- and long-term goals and objectives.
• Analyzes departmental strengths, weaknesses, opportunities, and constraints to give direction to staff in working toward meeting objectives.
• Maintains regular and predictable attendance.
• Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practice.
• Works to encourage and promote Company culture throughout the organization.
• Other duties as may be assigned

QUALIFICATIONS

• Doctor of Pharmacy (PharmD) Degree
• 5 years of pharmacist experience required
• 4+ years managed care, payer and PBM environment experience
• 4+ years of experience designing clinical programs which achieve improved clinical outcomes and affordability for populations with complex medical needs
• 3+ years of experience leading projects across cross functional teams in a large, matrix organization
• Some leadership-level experience and documented record of success in management of multi-disciplinary pharmacy operations preferred
• Competency in compendia navigation and research
• Outstanding negotiation, presentation, and facilitation skills
• Adaptive to high pace and changing environment
• Proven effective supervisory and leadership traits to manage and direct others
• Knowledge of medical and pharmacy products
• Basic understanding of provider reimbursement methodologies, including fee schedule pricing, DRG reimbursement, bundled outpatient hospital payment mechanisms, capitation, risk sharing arrangements and other payment methodologies
• Demonstrated consumer healthcare market understanding/knowledge required
• Licensed in Georgia to practice Pharmacy, or eligible for licensure in the state of Georgia to practice Pharmacy
• Experience in the ideation and design of engagement algorithms which leverage prescription claim, pharmacist assessment and individual member data to determine clinically sensitive times to outreach members resulting in increased engagement in clinical programs
• Experience designing and overseeing clinical programming which lead revenue generation or cost saving in multiple consecutive years

PHYSICAL REQUIREMENTS Prolonged periods of sitting at a desk and working on a computer. Moderate to significant amount of stress in meeting deadlines and dealing with day-to-day responsibilities. Must be able to drive a vehicle and daytime/overnight travel as required.

BENEFITS

• 401K (4% Match, Immediate Vesting)
• Accident insurance
• Competitive salary
• Critical Illness Insurance
• Dental Insurance
• Employee Assistance Program
• Flexible Spending Account
• Health & Wellness Program
• Health Savings Account
• Life & AD&D Insurance
• Long Term Disability
• Medical Insurance
• Paid Time Off
• Pet Insurance
• Short Term Disability
• Vision Insurance

PRE-EMPLOYMENT SCREENING

• Drug Screen and Background Check Required

HEALTHONE IS AN EQUAL OPPORTUNITY EMPLOYER

All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, disability, sex, age, ethnic or national origin, marital status, sexual orientation, gender identity or presentation, pregnancy, genetics, veteran status or any other status protected by state or federal law.