Staff VP Specialty Pharmacy Clinical Operations

Staff VP, Specialty Pharmacy Clinical Operations

CarelonRx, a proud member of the Elevance Health family of companies, leverages the power of new technologies and a strong, clinical-first lens to deliver member-centered, lasting pharmacy care. This role requires associates to be in-office at least three days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.

The Staff VP, Specialty Pharmacy Clinical Operations, will oversee the Clinical COE of BioPlus Specialty Pharmacy, including the recently integrated Kroger Specialty Pharmacy. Key objectives of this role include improving patient care outcomes, enhancing service delivery, and ensuring regulatory compliance. Functions that this role oversees include case management, prescription verification, care management, nursing, and clinical program development.

Position Responsibilities:

• Manage the specialty pharmacy management strategy across both pharmacy and medical for the enterprise.
• Participate in clinical program/policy development.
• Manage Strategic Business Unit drug trend and drug spend per member per month (PMPM).
• Oversee the development and maintenance of member/provider communications associated with safety and quality of care programs.
• Establish drug benefit design strategies to ensure affordability, generic utilization, and medication adherence in compliance with contract language and state/federal regulations.
• Oversee a cross-functional team of clinical, analytic, and pharmacy subject matter experts.
• Provide regulatory/legislative expertise on pharmacy issues.
• Provide support to grow and sustain membership with subject matter expertise in response to RFPs and participation in client meetings as requested.
• Interface with Health Plan stakeholders, Pharmacy Benefits Management (PBM) leadership, and senior management.
• Hire, train, coach, counsel, and evaluate the performance of direct reports.

Position Requirements:

• BA/BS and pharmacist license in applicable states, with a minimum of eight years of experience in a PBM clinical pharmacy, which includes a minimum of three years of management experience leading clinical professionals; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

• Proven track record of managing clinical operations.
• Strong leadership and managerial skills with experience leading large, diverse teams.
• Ability to inspire and motivate teams towards achieving key organizational objectives.
• Understanding of clinical program development, case management, prescription verification, and patient care processes.
• Experience in care management within a pharmacy setting.
• Thorough understanding of industry regulations and compliance requirements, including those relevant to specialty pharmacy and healthcare services.
• Demonstrated ability to develop and implement strategies that improve patient care outcomes and enhance service delivery.
• Excellent communication and interpersonal skills with the ability to collaborate effectively with internal and external stakeholders.
• Strong analytical and problem-solving skills to address operational challenges and optimize processes.
• Proven capability in driving continuous improvement initiatives and implementing innovative solutions in clinical operations.

Corporate Title: Staff VP, Clinical & Spec Pharm

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.