Manager - Clinical Pharmacy

Government Employees Health Association • Summit, NJ

10d • Hybrid

About The Position

Government Employees Health Association, Inc. (G.E.H.A) is a nonprofit member association that provides health and dental benefits that millions of federal employees and retirees, military retirees and their families have counted on since 1937. Offering one of the largest health and dental benefit provider networks available to federal employees in the United States, G.E.H.A empowers health and wellness by meeting its members where they are, when they need care. G.E.H.A has one mission: To empower federal workers to be healthy and well. The Clinical Pharmacy Manager will oversee the clinical aspects of managing the GEHA pharmacy benefit. This position will provide clinical leadership and oversight within the pharmacy department including direct reports and associated functional teams. This leader will work in tandem with other division leaders, and partner cross-functionally to assist with corporate strategy in achieving better healthcare value and lower cost for our members, while ensuring evidence-based pharmaceutical care. The Clinical Pharmacy Manager will also work in conjunction with division leadership to execute GEHA’s plan for growth, differentiation, and development. This role should be able to meet business needs, adapt to frequent changes and possess a strong skill set for problem-solving and process improvement. The position will be responsible for the following: Insuring evidence-based medication utilization among our membership through prior authorization criteria development and implementation Upholding defined clinical turnaround times and goals set forth in current contracts, accreditation standards and corporate guidance Providing clinical insight and leadership to direct reports Reviewing formulary, utilization management, and drug pipeline guide GEHA decision making SKILLS Duties and Responsibilities

Requirements

• Doctor of Pharmacy (PharmD) degree from an ACPE-accredited School of Pharmacy
• Candidate must be licensed, or eligible for licensure, within the state of Missouri
• Candidate must have 3 years of health plan experience
• Candidate must have experience leading direct reports or cross-functional teams
• Candidate must have experience with healthcare claims data (medical and pharmacy)
• Strong collaboration and partnership skills
• Exemplary organizational skills with the ability to handle multiple projects/issues simultaneously
• Must possess clear and demonstrative decision-making skills
• Demonstrate independent, critical thinking skills to understand individual and operational problems and identify solution(s)
• Candidate should possess an extensive understanding of evidence-based pharmacy practice, including disease specific therapies along with knowledge and ability to search medical literature for supporting clinical references
• Demonstrate stability of performance under pressure and/or opposition
• Proficient in Microsoft Office (Outlook, Word, Excel, Vizio and Microsoft Teams)
• Solid understanding of government scope (FEHB, OPM, FDA, ACA, USPSTF)
• Competency in compendia navigation and research
• Excellent record keeping skills, thorough documentation, clear and concise written/verbal communication style
• Must have the ability to provide a non-cellular High Speed Internet Service such as Fiber, DSL, or cable Modems for a home office. A minimum standard speed for optimal performance of 30x5 (30mpbs download x 5mpbs upload) is required. Latency (ping) response time lower than 80 ms Hotspots, satellite and wireless internet service is NOT allowed for this role.

Nice To Haves

• MBA or demonstrated business background
• Knowledge of the Medicare Advantage benefits
• Knowledge of NCQA (HEDIS®) technical specifications
• Federal Employee Health Benefit (FEHB) experience

Responsibilities

• Responsible for the day-to-day clinical management of the pharmacy benefit, team, and deliverables
• Provide clinical guidance, support and oversight to the assigned clinical team
• Independently completes accurate and comprehensive clinical review of internal and external impacts; provides recommendations as applicable
• Serves as clinical pharmacy SME on projects and clinical care activities
• Works across internal teams and partners to align strategic initiatives related to HEDIS and member experience optimization
• Works in partnership with division leadership to implement and maintain regulatory compliance (AAAHC, OPM, OIG, etc)
• Serve as point of contact for (case management, medical management, appeals, quality, marketing, customer service, customer experience, etc). related to clinical insights and corporate needs
• Responsible for budget and staffing recommendations and decision for the department

Benefits

• Competitive pay/salary ranges
• Incentive plan
• Health/Vision/Dental benefits effective day one
• 401(k) retirement plan: company match – dollar for dollar up to 4% employee contribution (pretax or Roth options) plus a 6% annual company contribution
• Robust employee well-being program
• Paid Time Off
• Personal Community Enrichment Time
• Company-provided Basic Life and AD&D
• Company-provided Short-Term & Long-Term Disability
• Tuition Assistance Program

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: Ph.D. or professional degree