Pharmacy Dir

Amerihealth Caritas•,

2d•Remote

About The Position

The Pharmacy Director will serve as the market pharmacy subject matter expert, collaborating daily with internal departments and the PBM while managing requests from State regulators. As a key member of the plan’s management team, this role will oversee the clinical and operational aspects of the pharmacy benefit, with a focus on improving outcomes and providing cost-effective care for Long-Term Services and Supports (LTSS) members enrolled in the Pennsylvania Community HealthChoices (CHC) program.

Requirements

Pharm.D. required
Registered Pharmacist with a current, active, unrestricted Pharmacist license in Pennsylvania, where the plan operates.
Minimum of three (3) working years of Medicaid pharmacy benefits management experience required. Retail/community pharmacy experience alone does not meet the requirements for this position.

Responsibilities

Monitor the following systems and programs for maximum effectiveness, efficiency, and return on investment.
Develop and implement, in collaboration with the PBM, new process improvements and programs, analyze and evaluate ongoing effectiveness, identify and implement enhancements:
PBM oversight, including monitoring of benefit configuration and claims adjudication accuracy, formulary compliance, SLAs, as well as annual review of P&P and reference guides.
Ensure compliance with all applicable state requirements.
Provide plan-specific Pharmacy SME support as needed by local plan and/or corporate projects.
Partner with and/or direct PBM in the development of innovative programmatic solutions to improve medication adherence and compliance. Collaborate with appropriate corporate partners to ensure these programs are implemented across all applicable lines of business.
Review clinical/financial recommendations and strategies provided by the PBM’s clinical pharmacists to determine feasibility and appropriateness, and ensure flawless implementation of these initiatives. Monitor the initiatives to measure results.
Monitor pharmacy trends; recommend process, product, and program improvement; plan, implement, and monitor changes.
Review pharmacy utilization reports generated by PBM, in coordination with the PBM clinical team, in a collaborative effort to improve quality and contain costs.
Support medical management goals by being a point person for the implementation of all pharmacy-related clinical programs and initiatives.
Work with PBM to identify and resolve any operational issues.
Provide support and attend all pharmacy-related meetings and committees sponsored by the line of business; participate on the Enterprise P&T Committee.
Generate necessary provider and member communications related to the pharmacy program.
Keep abreast of industry trends and regulatory changes in the pharmacy industry and evaluate their effect on pharmacy contracts and services.
Provide on-site education and training for the line of business’s Providers on formulary and pharmacy procedures.
Develop strategies, along with our PBM partners, to improve HEDIS ratings and other quality measures.
Ensure compliance with NCQA accreditation standards.
Participate in on-site visits to hospital systems, selected physician group practices, and pharmacies.
Act as the main point of contact for physicians and plan staff who are experiencing problems with the pharmacy program (decision, process, timeliness, etc.).
Act as the main point of contact for the State Agency and respond to all pharmacy inquiries in a timely manner.
Support the Fraud and Abuse program system oversight.
Communicate any suspected fraud discovered by the contact center staff. Recommend a course of action for Providers where patterns appear outside of guidelines and generally accepted pharmacy standards.
Work closely with PBM to ensure appropriate provider/member outreach is made at the local level to improve overall program quality.
Coordinate with a line of business’s compliance team on key operational and medication management issues identified through plan oversight and monitoring of PBM.
Identify cost containment initiatives specific to line of business; make recommendations and offer program improvements; coordinate initiatives with PBM.
Develop/build relationships with the local behavioral health providers, PerformCare staff, and PBM with the goal of improving the delivery of health care programs.
Create and support an environment that fosters teamwork, cooperation, respect, and diversity.
Collaborate and coordinate with PBM to create opportunities and efficiencies, and improve and create value within the Enterprise.
Supervise and develop pharmacy technicians to support the plan’s needs.
Perform other job-related duties, as assigned.