Manager Pharmacy Services HFHP - Pharmacy

Pharmacy Services Manager

Responsible for overseeing business and performance processes of the pharmacy services department, including formulary adherence, drug utilization, cost analysis, member service, STARs, and coverage determination/exception processes. Ensure that the pharmaceutical departmental operations are adherent to all legal, accreditation, and certification requirements and are accurately documented by the staff.

Primary Accountabilities:

• Act as the health plans representative for pharmacy initiatives and work in collaboration with the other pharmacy departments throughout the health system promoting cost-effective, appropriate, and safe medication use.
• Manage the implementation of pharmacy initiatives using PBM client portal functions and Rx/Medical claims data management.
• Work in collaboration with leadership across the organization towards the advancement of Medicare Stars performance and MTM programs.
• Act as a subject matter expert for the pharmacy services department for Medicare requirements and regulations.
• Collaborate with other departments across the health plans to ensure compliance with quality standards established by NCQA, HEDIS, CMS, and the State of Florida.
• Work in partnership with the Pharmacy Directors on issues surrounding regulatory compliance. Manage and ensure accurate operational processes for the timely resolution of coverage determination and exception requests that meet all regulatory requirements through the use of monitoring tools and established metrics for pharmacy processes.
• Establish, follow, and annually update policies and procedures that are compliant with both State and Federal regulations (including CMS) in conjunction with HP pharmacy leadership.
• Active involvement in P&T Committees across Health First assisting in the development and implementation of treatment criteria, drug use protocols, and drug utilization management programs.
• Manage and facilitate audit activities that include mapping, observing, interviewing and outcomes analysis as determined by the scope of the audit.
• Actively perform drug utilization reviews with cost/benefit analysis as part of IDN wide and plan specific cost savings initiatives.
• Provide guidance to Pharmaceutical Services team, and take responsibility for team activities while providing regular performance feedback that both develops and encourages growth.

Work Experience:

MINIMUM QUALIFICATIONS:

• Education: Doctor of Pharmacy (Pharm.D)
• Licensure: Registered Pharmacist (RPh) licensure in the State of Florida
• Certification: None Required
• Work Experience: 5 years' experience in the pharmacy field with either managed care, or PBM experience

Knowledge/Skills/Abilities:

• Understand all the functions of a pharmacy benefit management company.
• Experience in using pharmacy benefit software and managing functions performed by a full-service PBM company.
• Exceptional interpersonal relationship skills.
• Exceptional customer and member service skills.
• Proficient in word processing, graphics and spreadsheet manipulation and basic understanding of the Internet.
• Demonstrate excellent written and verbal communication skills conforming to all rules of punctuation, grammar, diction and professional style.
• Experience in initiating, developing and monitoring policies, internal control procedures and operating standards.
• Experience in monitoring metrics and trends around pharmacy processes.
• Ability to conduct training and make oral presentations to large and small groups.

PHYSICAL REQUIREMENTS:

• Sedentary – Office Workers
• Majority of time involves sitting or standing; occasional walking, bending, stooping.
• Long periods of computer time or at workstation.
• Light work that may include lifting or moving objects up to 20 pounds with or without assistance.
• May be exposed to inside environments with varied temperatures, air quality, lighting and/or low to moderate noise.
• Communicating with others to exchange information.
• Visual acuity and hand-eye coordination to perform tasks.
• Workspace may vary from open to confined.
• May require travel to various facilities within and beyond county perimeter; may require use of personal vehicle.

Benefits:

ABOUT HEALTH FIRST:

At Health First, diversity and inclusion are essential for our continued growth and evolution. Working together, we strive to build and nurture a culture that recognizes, encourages, and respects the diverse voices of our associates. We know through experience that different ideas, perspectives, and backgrounds create a stronger and more collaborative work environment that delivers better results. As an organization, it fuels our innovation and connects us closer to our associates, customers, and the communities we serve.

Schedule: Full-Time

Paygrade: 40