Director, Clinical Systems Operations (Pharmacy)
About The Position
Oversee the development, implementation, and operation of medical management information systems and technology solutions that meet Corporate, Health Plan, and Specialty business unit needs. This remote role supports Eastern or Central business hours and leads Clinical Systems for the Pharmacy team, managing a team of 11 individuals, including 4 direct reports. The role coordinates more than 50 clinical program and initiative workflows across various business rules and oversees more than 10,000 programmed communications to members, providers, and pharmacies, with annual volume exceeding 8 million. It manages systems supporting direct clinical interactions with members and other clinical program activities, including business rules for clinical data informatics that identify populations and medication-related problems by connecting eligibility, medical, and pharmacy claims data across large data sets. It also manages program triage to pharmacists and technicians according to program type, language, and state board of pharmacy licensure rules. The Director oversees system documentation and enhancements, business cases and requirements, regulatory programming and reporting requirements, software defects, new feature implementation, vendor activities, system integrations, and User Acceptance Testing (UAT), partnering closely with IT to support system and program needs. The role may require travel up to 30% of the time.
Requirements
- Bachelor's degree in Nursing, Computer Science, Business Administration, MIS, or a clinical-related field, or equivalent experience.
- 7+ years of applications, project management, or implementation experience.
- Previous management experience, including hiring, training, assigning work, and managing staff performance.
Nice To Haves
- Prior ownership of clinical applications.
- Clinical systems operations leadership experience.
- Pharmacy or managed care operations experience.
- Regulatory compliance and reporting experience.
- Vendor management experience.
- Healthcare technology platform management experience.
- Workflow and process optimization experience.
- Cross-functional leadership experience.
Responsibilities
- Oversee the development and functionality of clinical systems and programs to improve efficiency and effectiveness, including system design and requirements gathering.
- Provide direction and guidance to business functions to ensure systems meet business expectations and align with standard solutions and processes.
- Evaluate systems and program performance, recommend improvement opportunities, and implement changes.
- Oversee implementations of new clinical systems and upgrades and modifications to existing clinical systems.
- Oversee the investigation and resolution of issues involving clinical systems.
- Lead Clinical Systems for the Pharmacy team and coordinate clinical program and initiative workflows.
- Manage systems supporting direct clinical interactions with members and other clinical program activities.
- Provide business rules for clinical data informatics to identify populations and medication-related problems using linked eligibility, medical, and pharmacy claims data.
- Manage program triage to pharmacists and technicians based on program type, language, and state board of pharmacy licensure rules.
- Oversee system documentation and enhancements, business cases and requirements, regulatory programming and reporting requirements, software defects, new feature implementation, vendor activities, system integrations, and UAT.
- Partner closely with IT to support system and program needs.
- Manage staff, including hiring, training, assigning work, and managing performance.
- Travel up to 30% of the time.
Benefits
- Competitive pay
- Health insurance
- 401K
- Stock purchase plans
- Tuition reimbursement
- Paid time off
- Holidays
- Flexible approach to work with remote, hybrid, field, or office work schedules
- Additional forms of incentives may be included in total compensation, subject to applicable terms and eligibility.
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What This Job Offers
Job Type
Full-time
Career Level
Director
