Manager, Medical Drug Strategy & Execution

CareSource • Dayton, OH

19h

About The Position

The Manager, Medical Drug Strategy & Execution is responsible for leading the development of medical drug strategy, overseeing the execution of specialty and physician administered drug operations, and ensuring compliance across all initiatives.

Requirements

• Bachelor's degree in Pharmacy required or Doctorate of Pharmacy (Pharm.D.) required
• Five (5) years of experience in Managed Care required
• Three (3) years of Specialty Pharmacy/Medical Drug Management required
• Experience in data analysis and trending required
• Advanced proficiency level with Microsoft Outlook, Work, Excel, and PowerPoint
• Knowledge of specialty pharmacy and medical drug management standards and practices
• Communication skills
• Management and prior supervisory skills
• Ability to work independently and within a team environment
• Attention to detail
• Familiarity of the health care field
• Critical listening and thinking skills
• Training/teaching skills
• Strategic management skills
• Negotiation skills
• Proper grammar usage
• Change resiliency
• Technical writing skills
• Time management skills
• Proper phone etiquette
• Customer service oriented
• Decision making/problem solving skills
• Leadership skills
• Unrestricted registered pharmacist (RPh) Licensure in state of practice required
• Ability to acquire pharmacist licensure in multiple states, as required

Nice To Haves

• Previous management experience preferred

Responsibilities

• Coordinate the implementation and execution of medical drug strategy and management of the pre-determination process for specialty pharmacy.
• Drive biosimilar adoption, utilization pathways, clear/white bagging policies, specialty pharmacy partnerships, and sourcing strategies.
• Optimize infusion and specialty drug administration settings for cost savings and improved outcomes.
• Lead execution of CMS/state drug requirements across systems and providers, Part B Implementation.
• Lead QAI efforts for medical drug spend and utilization support cost containment and driving medical forecasting for consistent execution.
• Coordinate and collaborate with Pharmacy, Medical, Network, Finance, and Operations to ensure unified execution.
• Assist in the development of integrated service delivery to members and oversee data and processes to maintain industry standards and practices.
• Assist the Director in developing processes to manage appropriate utilization and assure appropriate payment for specialty/medical drug services and programs.
• Interact with providers and staff to manage benefits aligned with regulations, URAC and NCQA regulations and CareSource policies and vision.
• Oversee CQI (Continuous Quality Improvement) activities and document departmental processes for internal and external use.
• Review and revise workflows to maximize efficiencies.
• Monitor productivity and utilization trends.
• Regularly report all specialty pharmacy/medical drug data and program performance.
• Ensure compliance with and reporting of all regulatory requirements.
• Analyze and formulate recommendations based on data.
• Maintain and update all departmental policies and procedures.
• Act as liaison with other departments to assist with research and intervention.
• Perform any other job related duties as requested.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager