Director of Pharmacy Services

Colorado Access•Denver, CO

1d•$210,000 - $225,000•Hybrid

About The Position

Colorado Access is a Colorado-based company dedicated to improving the health of the state by serving individuals, families, and children who receive healthcare through Child Health Plan Plus (CHP+) and Health First Colorado. The organization focuses on enhancing quality, member experience, outcomes, and cost. This role is crucial in shaping the company's vision and supporting its mission. The Director of Pharmacy Services will manage the Pharmacy Benefit Management Contract, oversee drug benefit programs for Medicaid, CHP+, and the marketplace, and serve as a pharmaceutical consultant. This position involves managing vendor relationships, ensuring compliance, monitoring customer service issues, and evaluating the drug formulary. The role also includes facilitating the Pharmacy & Therapeutics Committee, communicating protocols to providers, developing prior authorization criteria, and implementing drug utilization review profiling. Additionally, the director will supervise pharmacy-related staff, represent Colorado Access at state government meetings, and ensure compliance with regulatory requirements. The position also involves active participation in Quality Improvement projects and developing policies and procedures for pharmacy operations. Department Director responsibilities include providing strategic direction, building high-performing teams, fostering collaboration, and making tactical decisions to advance company goals. The role also oversees cross-functional projects and ensures compliance with all relevant regulations.

Requirements

Doctor of Pharmacy Degree (PharmD) required.
Minimum of five years of progressive Pharmacy supervisory/management experience is required.
Three years of hospital or home health care experience required.
One year of managed care experience required.
Pharmacy and Therapeutics Committee and Drug Utilization Review/Drug Use Evaluation (DUR/DUE) experience required.
Contract management, DUR/DUE, P&T committee; Strategic business planning, change management, people management and project management skills required.
Demonstrates support for the company’s mission, vision and values.
Requires strong analytical and problem-solving skills.
Position requires excellent written and verbal communication skills with public speaking/presentation experience.
Strong interpersonal and relationship building skills; ability to develop strategic partnerships and work with all levels of staff.
Strong organizational and time management skills with the ability to multi-task.
Must be proficient in Microsoft office applications (Word, Excel, PowerPoint).
Requires the ability to use the complaint, grievance and appeal process, and procedures to facilitate quality outcomes and/or resolutions for the benefit of the members, providers, and Colorado Access.
May be required to manage multiple priorities and projects with tight deadlines.
Active Colorado PharmD licensure required.
A valid driver's license and proof of current auto insurance will be required for any position requiring driving.

Nice To Haves

Residency preferred.

Responsibilities

Evaluates, develops and maintains an effective pharmacy program by managing the Pharmacy Benefit Management Contract for Colorado Access.
Manages the Pharmacy Benefit Manager contract, delegation and relationship, ensuring compliant vendor activities.
Provides oversight and management of all aspects of the Medicaid, CHP+ and marketplace drug benefit programs.
Monitors and ensures resolution of customer service problems involving the pharmacy contractor, including profiling trends and developing proactive interventions.
Serves as pharmaceutical consultant to teams across the company that work on related projects and contracts.
Responsible for ongoing evaluation of the drug formulary.
Serves as facilitator and provides support to the Pharmacy & Therapeutics Committee. Keeps committee members informed of potential issues and maintains effective communication of formulary changes with providers.
Communicates protocols to home health pharmacy providers and monitors compliance.
Works with pharmacy contractors, clinical consultants, the Medical Director, and the Pharmacy & Therapeutics Committee to develop prior authorization or exception criteria and prescribing protocols for oral, topical, infusion, and injectable medications.
Works with the pharmacy contractor and/or Decision Support to develop and implement standard and customized physician/pharmacy drug utilization review profiling.
Supervises the research and presentation of quality indicators and utilization profiles to the Pharmacy & Therapeutics Committee.
Attend meetings to address pharmacy benefits and operational issues.
Represents Colorado Access at state government-level meetings, as appropriate.
Develop and monitors pharmacy systems to assure compliance with all regulatory, contract, and NCQA requirements.
Actively participates in Quality Improvement projects and presents findings to appropriate Quality Improvement Committees.
Develops policies, procedures, and the operating structure for pharmacy-related quality improvement initiatives and daily operations.
Supervises pharmacy-related staff, including recruiting, interviewing, hiring, coaching, counseling, and completing performance evaluations.
Interacts regularly with the Colorado Access provider network and serves as a key liaison regarding pharmacy issues among the health plan, members, and provider community.
Understands, communicates, and facilitates the complaint, grievance, and appeal process on behalf of members, providers, and ancillary suppliers, including advising these groups of existing resources and initiating processes on their behalf.
Provides oversight of automated review.
Provides strategic direction and oversees the management and maintenance of multiple pharmacy department deliverables striving for operational excellence (productivity, quality, SLAs, customer experience of services provided, etc.).
Builds high performing teams with vision, leadership, goals and metrics.
Serves as a role model for team members; takes action and inspires team members to embrace and implement culture initiatives.
Provides awareness to department leaders and staff how their work impacts other departments, programs and the enterprise.
Encourages collaboration and holds team members accountable for achieving outstanding results.
Works closely with other directors to make tactical and operational decisions that advance company strategies and goals and collaborates to deliver on company-wide deliverables/requirements.
Oversees/leads projects and continuous improvement initiatives across cross-functional teams.
Develops and implements department policies and procedures to ensure compliance with federal, state, local and company policies, rules and regulations.

Benefits

PTO
floating holidays
nine company paid holidays
Employee Assistance Program
401K
tuition reimbursement
leadership training
promotion opportunities
performance evaluations
employee recognition
language pay stipend
Medical, dental, vision insurance that starts the first day of the month following start date.
Supplemental insurance such as critical illness and accidental injury.
Health care and dependent care flexible spending account options.
Employer-paid basic life insurance and AD&D (employee, spouse and dependent).
Short-term and long-term disability coverage.
Voluntary life insurance (employee, spouse, dependent).
Retirement plan
Annual bonus program (based on eligibility, requirements and performance).