• Director, Medicaid Clinical Pharmacy

    Job Locations US-VA-Glen Allen
    Job ID
    2018-4934
  • About Us

    Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.
    By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.
     
    At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.
     
    If this sounds like you, read on!

    Overview

    This role will manage and coordinate all aspects of Virginia Premier's Medicaid Pharmacy Programs, ensuring Pharmacy Management is positioned to optimize performance in terms of compliance, quality, service, affordability and technology as it relates to clinical pharmacy management.  This position is expected to build strong collaborative relationships with other key leaders in the organization to ensure efficiency of operations and alignment of resources across the Enterprise.   Clinical Pharmacy Management is expected to engage with Network Providers (physicians, pharmacists, advanced practice nurses, etc.) to find new and effective ways to achieve system wide improvements in patient care outcomes.  This position consistently supports clinical compliance with all regulatory authorities (including DMAS and CMS) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to the applicable federal, state and local laws and regulations, accreditation and license requirements and Virginia Premier's Policies and Procedures.

    Responsibilities

    • Provides executive leadership and direction in the development and execution of strategy for the delivery of clinical pharmaceutical care, service and operations across the Enterprise necessary to achieve high quality affordable care and improvement in the health of our members.
    • Responsible for productivity, operational and quality metrics related to Medicaid pharmacy programs. Assists in implementation of the health plan pharmacy goals to ensure clinical, quality and financial goals are met.
    • Develops and implements clinical quality assurance activities to ensure regulatory and clinical policy compliance.
    • Implementation of point of sale intervention, retrospective drug utilization review, polypharmacy, pharmacist case management, retrospective DUR, medication therapy management, disease management, and other clinical programs.
    • Promotes a high level of collaboration between pharmacy leadership, physician leadership and nurse leadership to leverage pharmaceutical and medical expertise for purposes of improving health, promoting quality care, assuring appropriate use of medications, and prudent use of resources.
    • Provides high level of pharmacy data analysis and extracts to ensure that departmental goals are met. This would include PMPM trending, PMPM actual vs. target, rebate savings/loss, and formulary change savings/loss.
    • Provide executive clinical leadership and direction in the negotiation of contracts with outside vendors, specifically a national Pharmacy Benefit Management company (PBM) and managing those relationships for the administration of prescription drug benefits that are responsive to the marketplace in the delivery of consistent high performance services across all pharmacy practice settings with an emphasis on quality, service and affordability.
    • Provides executive clinical leadership and oversight to assure high quality policies are developed to promote evidence based formulary decisions, drug use management initiatives, and assure the quality of pharmaceutical care and services across the Enterprise. Continued review and development of a comprehensive formulary.
    • Collaborates with representatives of Government Relations to influence public policy related to pharmacy services, pharmaceuticals, drug benefits, drug costs and market competition.
    • Supervision of the Pharmacy Technician

    Qualifications

    MINIMUM EDUCATION REQUIREMENTS

    • Undergraduate degree in pharmacy
    • Current Pharmacy license in Virginia/or eligibility is required
    • Doctor of Pharmacy (PharmD) preferred 

     SPECIAL KNOWLEDGE AND/OR SKILLS 

    • Excellent communication and presentation skills, both verbal and written are essential
    • Familiarity with computers, diverse software packages, statistics and research design and regulatory (CMS, FDA, NCQA, URAC, and DMAS) strongly preferred
    • Demonstrated ability to utilize effective communication, presentation, financial management, and analytical skills required. Demonstrated track record of self-initiative, strategic thinking, and successful planning and innovation.
    • Demonstrated ability to work collaboratively with physicians and health care administrators.
    • Understanding of Pharmacy, Medical, Nursing and other applicable health care laws, regulations and compliance standards.
    • Proven ability to lead and manage through influence and change, achieve performance outcomes through others, and galvanize action through synthesis and interpretation of data.
    • Demonstrated success in meeting/exceeding performance expectations, with consistent delivery of results to the satisfaction of internal and external customers/patient populations.
    • Proven ability to balance execution of the strategic vision through leadership and delegation, with a willingness and competence to dive into the details.
    • Decisiveness, action-orientation, personal integrity, capability to persevere in difficult situations and a focus on strategic leadership issues highly desired. Incumbent should also possess an open, collaborative leadership style.

     WORK BACKGROUND/EXPERIENCE

    • Minimum of 5 years relevant experience with demonstrated and documented record of success in management of multi-disciplinary pharmacy operations, required in either a health plan, PBM or related company or institution
    • Prior experience managing a Medicaid and or Medicare Part-D pharmacy benefit
    • Experience and hands on knowledge negotiating and managing the relationship with a Pharmacy Benefit Manager (PBM), preferred
    • Experience with underserved populations, state Medicaid plans and CMS very helpful.
    • Extensive clinical strategy and operations experience and demonstrated success in managerial roles in a multi-faceted health care company, system or institution required.
    • Extensive knowledge of and leadership experience in quality oversight, accreditation and regulatory compliance, integrated care delivery systems and coordinated care.
    • Knowledge and experience in internal Pharmacy Services and Pharmacy Benefit operations, systems, technology, and management. Demonstrated ability to apply and utilize knowledge of quality, utilization, formulary management in a health plan setting.
    • Successful experience managing a broad range of operations and organizational issues, such as organizational re-design, improving internal operations, creating a performance-oriented organization, and change management. 

    PHYSICAL REQUIREMENTS

    • Physical health sufficient to meet the ergonomic standards and demands of the position

     

    Equal Opportunity Employer All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

     

    Our mission is to inspire healthy living within the communities we serve!

     

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