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Director, Pharmacy Benefits Management Operations at Advantasure in Richmond, Virginia

Posted in Other 30+ days ago.

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Job Description:

SUMMARY:

This position is responsible for integrating a Pharmacy Benefit Management (PBM) component to the Healthcare Solution. Providing full service, integrated PBM services, including network-pharmacy claims processing, mail order, benefit design consultation, drug utilization review, formulary management, and other related services. This position is responsible for developing and enhancing product programs and adherence.

RESPONSIBILITIES/TASKS:
  • This position is responsible for the oversight of all PBM activities.
  • Maintain adherence program through consumer identification, notification, and intervention.
  • Report on adherence outcomes.
  • Maintain a vigorous and continuous quality improvement process for all PBM program consumers, providers and clients.
  • Monitor acumen data for patient safety and high risk management to obtain desired CMS Star Ratings.
  • Perform comprehensive medication reviews and project the number needed.
  • Review staffing needs to ensure comprehensive medication reviews are being achieved.
  • Oversee member and physician mailings.
  • Measure key quality metrics including best practices and participant satisfaction.
  • Evaluate and disseminate consumer education and other referral sources as applicable, taking into account demographics, literacy, cultural diversity and language barriers.
  • Ensure Pharmacy oversight of all PBM operations.
  • Assist Medicare compliance with respect to clinical activities.
  • Ensure completion of the Prescription Medication List (PMR).
  • Participate in the Quality & Compliance oversight.
  • Provide vision, leadership, planning, project coordination and management for the development of a cost-effective department while concurrently facilitating efficient operations to meet current and future business needs within the organization.
  • Represent company in community and industry, programs and conferences.
  • Participate in the development of programs as a strategic partner that supports the company plan.
  • Participate in development of annual departmental budget, monitor budget and identify budget discrepancies. Research cause and make recommendations.
  • Responsibility for balancing workload to optimize the effectiveness of the department.
  • Provide vision, leadership, planning, project coordination and management for the development of a cost-effective department while concurrently facilitating efficient operations to meet current and future business needs within the organization.
  • Represent company in community and industry, programs and conferences.
  • Participate in the development of programs as a strategic partner that supports the company plan.
  • Participate in development of annual departmental budget, monitor budget and identify budget discrepancies. Research cause and make recommendations.
  • Responsibility for balancing workload to optimize the effectiveness of the department.

DIRECTION EXERCISED:

Directly supervises exempt and non-exempt staff in accordance with company policies and applicable Federal and State Laws. Responsibilities include but are not limited to effectively interviewing, hiring, terminating, and training employees; planning, assigning and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems; supporting and encouraging the engagement process.
EXPERIENCE:

Ten years of progressively more responsible experience in a pharmacy benefit management environment with demonstrated technical experience that provides the necessary knowledge, skills and abilities. Five years of leadership experience in pharmacy benefit management required. Medicare Part D experience required. Medication therapy management (MTM) preferred. Crystal Reports and/or Business Objects experience preferred.

EMPLOYMENT QUALIFICATIONS:

EDUCATION:

Bachelor's degree in related field (i.e.: Pharmacy, Healthcare) or Pharm.D. Required.

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
  • Pharmaceutical and medical knowledge necessary to effectively discuss drug therapy issues with physicians and pharmacists.
  • Medicare Part D knowledge required.
  • Working knowledge of applicable state and federal pharmacy regulations.
  • Demonstrated ability to prepare and analyze reports containing healthcare utilization data.
  • Ability to articulate to people at all levels of an organization and possesses excellent communication skills.
  • Ability to educate, gain trust and willingness to share information and serve as a mentor.
  • Ability to work with peers in a team effort.
  • Demonstrated ability to manage multiple priorities and deadlines.
  • Ability to be organized and self-directed and work with minimal amount of supervision.
  • Capability to efficiently complete tasks in a fast paced environment.
  • Proficient in Microsoft Office and industry related software programs.
  • Must demonstrate leadership ability and team building skills to effectively supervise professional and non-professional staff and interact with all levels of management.
  • Ability to work with and empower others on a collaborative basis to ensure success of unit team.
  • Ability to effectively exchange information, in verbal or written form, by sharing ideas, reporting facts and other information, responding to questions and employing active listening techniques.
  • Ability to effectively present budgetary and/or cost information, and respond to questions as appropriate.
  • Ability to establish workflows, manages multiple projects, and meets necessary deadlines.

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

WORKING CONDITIONS:

Work is performed both in the office and in the field with minimal hazards. Travel required. May work extended hours, weekends and holidays pursuant with industry demands.

The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.

We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.