The Pharmacy Services Manager is responsible for initiating, performing, and completing activities to maintain and improve the quality and cost effectiveness of the pharmacy program for all product lines. The Manager monitors and measures the impact of pharmacy initiatives and programs and provides suggestions and direction to ensure appropriate, efficient pharmacy services are provided to BCBSM members.
Identify and develop program opportunities to improve the quality and cost-effective use of the BCBSM prescription drug benefit.
Manage BCBS's medication management activities. Review requests and provide determinations for approval or denial of medication requests, as appropriate.
Develop and maintain Blue Cross Blue Shield Formulary.
Participate in Pharmacy and Therapeutics Committee and other BCBS committees as requested. Develop and distribute reports to support integration of quality assurance utilization management, case management and pharmacy program cost analysis.
Develop responses relating to the pharmacy services area to support BCBS RFI and RFP activities.
Develop, enhance and support pharmacy quality initiatives such as drug use review/drug use evaluation, clinical improvement activities, etc.
Act as a liaison between pharmacy staff and the BCBS designated pharmacy benefit manager to ensure appropriate configuration to support BCBS's drug benefit.
Maintain regular communication with the PBM to monitor accuracy of claims processing and adherence to contract terms.
Support development, initiate implementation and provide continuous monitoring of activities to integrate medical and pharmacy claims for reporting purposes.
Participate on multidisciplinary teams.
Support activities relating to HEDIS, NCQA and regulatory requirements.
Meet with contracted physicians, administrators and other health care personnel in the community and within the plan to support BCBS's pharmacy initiatives.
Support regional Blue Cross Blue Shield initiatives.
Uses independent judgment to exercise authority on behalf of the company and recommends such actions in the following areas:
Conducts performance evaluations, counsels, coaches, and administers discipline.
Responsible for ensuring staff training and development
Keeps abreast of changes in corporate policies and procedures, and communicates changes with staff as appropriate.
Resolves employee complaints and concerns; maintains good employee relations
Develops and/or assists in budget preparation and adheres to budget.
Develops department goals and objectives and support the department's strategic planning.
Administers labor agreements and appropriate problem resolution including grievance handling.
Interviews and makes hiring and transfer recommendation/decisions in regards to staff for the department.
BS, Pharmacy required.
Current Michigan pharmacist license to practice without restriction required.
Doctor of Pharmacy preferred.
One (1) year of community or hospital experience preferred.
One (1) year of supervisory experience required (if a position with direct reports).
One (1) year of lead experience or project management experience required (if a position without direct reports).
One (1) year of experience in data analysis, report development and program development relating to managed care pharmacy preferred.
One (1) year of experience in managing the development and implementation of multiple complex projects simultaneously preferred.
Basic knowledge Microsoft Word, Excel, Access and PowerPoint required.
Ability to maintain a high level of confidentiality required.
Excellent verbal and written communication skills required.
Ability to manage, develop, and implement multiple complex projects simultaneously and meet required deadlines required.
Department Summary / Preferences:
Clinical or specialty pharmacy background; prefer experience with medical-pharmacy integration
Pharmacy residency preferred; ideally Drug Information, Managed Care or related field OR At least 3 years of experience in Drug Information, Managed Care or related field
Manage pharmacy and medical benefit drug pipeline including drug approval monitoring
Manage development and reporting of relevant drug pipeline information, including focused pipeline reports on generic drugs, biosimilars and gene and cellular therapies, to internal and external stakeholders
Manage preliminary/ pre-approval drug management and policy development
Manage monitoring and reporting of new drug approval information to internal stakeholders
Manage development of drug utilization management criteria reflecting best evidence and clinical practice guidelines
Coordinate BCBSM’s Pharmacy & Therapeutics (P&T) Committee meetings, including preparation and presentation of evidence-based drug reviews and policies; prefer P&T committee or related experience
Participate in multi-disciplinary clinical pharmacy strategy workgroup focused on pharmacy and medical benefit initiatives driving integration and innovation in the marketplace
Provide concise, comprehensive and timely responses to drug information inquiries for internal and external audiences
Lead team of clinical pharmacists; prefer minimum 3-5 years of leadership experience managing direct reports
Precept pharmacy interns, students and resident
All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.