Health Plan Pharmacy Services Director (Nevada)

Molina Healthcare•Long Beach, CA

9d•Remote

About The Position

JOB DESCRIPTION Job Summary Serves as the designated leader and subject matter expert for the assigned health plan pharmacy program(s) supporting quality, cost-effectiveness, and compliance initiatives. Works closely with corporate pharmacy leadership to ensure that the health plan pharmacy program is consistent with the enterprise pharmacy strategy. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. Work location - remote, will support the Nevada Health Plan Essential Job Duties Represents assigned Health Plan Pharmacy at meetings with state regulators as Pharmacy subject matter expert. Performs and compiles analysis on emerging trends, forecasts, and pharmacy spend and uses data in rate advocacy work with the state. Provides oversight and direction to centralized pharmacy utilization management team. Partners with internal and external customers to ensure prompt resolution of identified issues and serve as the first point of contact for internal departments. Collects and compiles data for reporting purposes and maintains files of confidential information submitted for review. Assures that activities and processes are compliant with National Committee for Quality Assurance (NCQA) guidelines and Molina policies and procedures and promotes best practice measures to ensure consistency. Communicates with practitioners, pharmacists, and drug representatives. Advises pharmacy leadership on operational issues, program and system needs, and regulatory changes. Supports development of policies and procedures. Participates in quality management and health education programs including, but not limited to NCQA accreditation, Healthcare Effectiveness Data Information Set (HEDIS), and disease management programs. Travel required (minimum 25%) to identified health plan (Nevada).

Requirements

At least 8 years of experience as a pharmacist, including 5 years in health care delivery, or equivalent combination of relevant education and experience.
Active and unrestricted pharmacy license in Nevada.
Excellent verbal and written communication skills.
Strong organizational and time management skills
Microsoft Office suite/applicable software program proficiency and Microsoft Excel expertise
Proficiency in compiling data, creating reports, and presenting information and ideas concisely to varied audiences.
Ability to develop and maintain positive and effective work relationships with coworkers, members, providers, regulatory agencies, and vendors.
Travel required (minimum 25%) to identified health plan (Nevada).

Nice To Haves

Managed care or Pharmacy Benefit Management (PBM) experience.
Knowledge of or experience with decision analysis and data analysis tools, such as SQL, Microsoft Access/Excel.

Responsibilities

Represents assigned Health Plan Pharmacy at meetings with state regulators as Pharmacy subject matter expert.
Performs and compiles analysis on emerging trends, forecasts, and pharmacy spend and uses data in rate advocacy work with the state.
Provides oversight and direction to centralized pharmacy utilization management team.
Partners with internal and external customers to ensure prompt resolution of identified issues and serve as the first point of contact for internal departments.
Collects and compiles data for reporting purposes and maintains files of confidential information submitted for review.
Assures that activities and processes are compliant with National Committee for Quality Assurance (NCQA) guidelines and Molina policies and procedures and promotes best practice measures to ensure consistency.
Communicates with practitioners, pharmacists, and drug representatives.
Advises pharmacy leadership on operational issues, program and system needs, and regulatory changes.
Supports development of policies and procedures.
Participates in quality management and health education programs including, but not limited to NCQA accreditation, Healthcare Effectiveness Data Information Set (HEDIS), and disease management programs.