Director- Hospital Pharmacy Services

Baystate Health•Springfield, MA

1d•Onsite

About The Position

The Director of Pharmacy Services is responsible for directing, leading, developing and implementing Pharmacy Services policies and initiatives for the provision of quality, cost-effective pharmaceutical care involving providers, members and employers. Specific activities include timely and accurate reporting of pharmacy financials with budgetary impacts and related regulatory reporting requirements, compliance, and other regulatory requirements. This position manages the Pharmacy Department team ensuring compliance with department policies and procedures, actively coaches staff, encourages personnel development and training, and project management as deemed necessary while staying in alignment with HNE’s mission, vision and corporate values. The Director of Pharmacy will also work with other members of ELT and the Director’s Team.

Requirements

Licensed Pharmacist RPh licensure with BS in Pharmacy (PharmD or MBA preferred) with more than 7 years of progressively responsible pharmacy experience in Managed Care and/or integrated delivery systems.
3 years leadership
5 years preceptor/educator experience
Proven management experience
Sound pharmacy and medical knowledge base and the desire to maintain and expand on this base with an strong understanding of health system operations
Knowledge of DOI, EOHHS and CMS rules and regulations for medical and pharmacy services.
Experience in pharmacy utilization analysis and reporting
Excellent organizational abilities
Self-directed, self-motivated and detail oriented
Excellent verbal and written communication skills
Computer experience with Microsoft Office programs with advanced excel skills
Strong interpersonal skills, able to relate to all levels of professionals
Excellent contractual negotiation skills

Nice To Haves

PharmD or MBA preferred

Responsibilities

Key contributor in the creation and deployment of HNE’s pharmacy and medical service strategy
Manages the functions and budgets of the commercial and government program PBMs, including retail, mail-order and specialty pharmacy.
Negotiate and manage supplemental rebate contracts for all lines of business
Manage the specialty pharmacy and home infusion relationship with Baystate Health, UMass Memorial Health Care, and other future system partners, e.g. Hartford Health Care.
Responsible for oversight of multiple vendors (e.g PBM, Medical pharmacy providers, etc.)
Responsible for overall management of greater than 20% of overall medical spend (>$250 million)
Develop and implement pharmacy initiatives within the Medical, Behavioral Health, and Disease Management programs.
Monitor pharmacy trend and utilization management activities with respect to pharmacy budget and medical budget for all three lines of business.
Identify, assess and make recommendations for medical management programs to enhance member compliance and appropriate use of pharmaceuticals.
Assess opportunities to coordinate with care management program.
Work collaboratively with other members of the CSI Management team and promote integrated clinical activities.
Represent the CSI Management team at Director’s meetings.
Review of outlier issues with the Clinical Pharmacist and / or Pharmacy Services Coordinator
Participate in and promote coaching activities.
Identify problems/issues and initiate corrective action.
Arrange and/or provide training of the Pharmacy Services staff.
Monitor NCQA and other regulatory compliance through audits and close interaction with the Pharmacy Supervisor and other related departments.
Continually evaluate the UM criteria sets utilized within Pharmacy and ensure that all designated staff is trained in their use.
Work cooperatively with Provider Relations, Finance & Healthcare Economics, Sales, Marketing, Member Services, Claims, ASO, other units within the Health Services division, and other HNE departments.
Represent HNE at the system level, and in state and national meetings, e.g. the Health Plan Alliance.
Represent HNE at MassHealth pharmacy-related meetings.
Project or product development or implementation as deemed necessary by the Medical Director, CM , CFO, or CEO including analysis and recommendations on pharmacy and medical trend.
Assist Medical Directors and Clinical Pharmacists in the identification and assessment of new pharmaceutical agents and payment methodologies.
Present as needed to HNE Management or Peer groups, including CLT, the Director Team and subcommittees.
Provides leadership and direction to department staff; establishes annual performance objectives and evaluates performance; determines personnel actions.
Provide sales support for prospective and current employer groups, broker including but not limited to evaluation of data, subject matter expertise around pharmacy trend and benefit design.
Provide support in development of rates for commercial and Medicaid rates for medical and pharmacy trends.
Provide support in Medicare bid development in working with both internal HNE associates and actuaries for medical and pharmacy.
Promote and seek opportunities to improve processes and identify areas of improvement.
Provides leadership and direction to department staff; establishes annual performance objectives and evaluates performance; determines personnel actions.
Provide subject matter expertise around pharmacy trends, benefit design, and new and emerging technology to multiple stakeholders including: Baycare, BH, providers, etc.
Develop, implement new and maintain current clinical quality and cost saving programs, and process improvements, with respect to pharmacy and clinically integrated activities.
Train and supervise Clinical Pharmacists to provide support for the Pharmacy Department.
Oversee UM guidelines and decisions for formularies for all lines of business.
Oversee Medicare formulary development and maintenance, reporting and reconciliation efforts.
Perform reviews of specific member/pharmacy requests for drugs under UM guidelines.
Identify and develop strategies for pharmacy related communications for physicians, members, internal departments and external customers.
Perform analysis of pharmacy data to identify opportunities to impact drug cost and utilization opportunities, including review of the monthly pharmacy and specialty pharmacy reports and the creation of new reporting tools as needed.
Meet with provider groups and PHOs to discuss pharmacy utilization and trends and make recommendations to improve provider performance. This will require traveling to network provider sites several times a quarter.
Work with HCE to develop provider pharmacy reports which are useable and actionable.
Will work alongside the sales team to analyze sales package reports for employer groups as needed.
Support internal departments such as Finance, Sales, Member and Provider Services through education about pharmacy issues and benefit updates, providing actual and trend data, etc.
Partner with Disease Management, Utilization Management, and Behavioral Health to provide integrated clinical services to HNE members.
Manage the Utilization Management (UM) processes, development of Quality Improvement Activities and the oversight of Delegation Agreements.
Chair Pharmacy and Therapeutics (P&T) Committee and participate in system-wide P&T
Provide clinical support for Medical Director and direction for the clinical pharmacist.
Coordinate with the PBM support team and clinical pharmacist for preparation of P&T materials
Provide support to the Clinical Pharmacist for coordination and presentation of materials for monthly P&T Committee in the evening.