Pharmacy Director

Amerihealth Caritas•Edgmont Township, PA

2d•Remote

About The Position

The Pharmacy Director serves as the market pharmacy subject matter expert and a member of the plan’s management team. The role oversees the clinical and operational aspects of the pharmacy benefit for Medical Assistance members enrolled in Pennsylvania HealthChoices, with a focus on improving outcomes and providing cost-effective care. The director collaborates with internal departments and the pharmacy benefit manager (PBM), manages requests from State regulators, and supports local plan and corporate projects. This is a remote position, but candidates must reside in Pennsylvania to meet contractual requirements. The role monitors PBM performance and pharmacy programs, ensures compliance with state requirements and NCQA standards, evaluates clinical and financial recommendations, and develops improvements to quality, medication adherence, and cost containment. It serves as a key contact for State agencies, physicians, plan staff, providers, and members regarding pharmacy program matters. The director also supervises and develops pharmacy technicians and performs other job-related duties as assigned.

Requirements

Pharm.D. degree.
Current, active, unrestricted Pennsylvania Pharmacist license.
At least three years of working experience in Medicaid pharmacy benefits management; retail or community pharmacy experience alone does not meet this requirement.
Highly effective communication skills and ability to establish relationships within and across departments.
Strong organization and responsiveness in a challenging environment that may require urgent turnaround times.
Innovative and strategic thinking.
Must reside in Pennsylvania to meet contractual requirements.
For fully remote work, access to reliable high-speed internet with at least 50 Mbps download and 5 Mbps upload.

Responsibilities

Monitor pharmacy systems and programs for effectiveness, efficiency, and return on investment.
Collaborate with the PBM to develop process improvements and programs, assess their effectiveness, and implement enhancements.
Oversee PBM benefit configuration, claims adjudication accuracy, formulary compliance, service-level agreements, and annual review of policies and procedures and reference guides.
Ensure compliance with applicable state requirements and NCQA accreditation standards.
Provide pharmacy subject matter expertise for local plan and corporate projects.
Partner with or direct the PBM in developing medication adherence and compliance programs, and coordinate implementation across applicable lines of business.
Review the PBM’s clinical and financial recommendations for feasibility and appropriateness, oversee implementation, and monitor results.
Monitor pharmacy trends and recommend, plan, implement, and monitor process, product, and program improvements.
Review PBM pharmacy utilization reports with the PBM clinical team to improve quality and contain costs.
Support medical management goals by coordinating implementation of pharmacy-related clinical programs and initiatives.
Work with the PBM to identify and resolve operational issues.
Support and attend line-of-business pharmacy meetings and committees, and participate on the Enterprise P&T Committee.
Generate provider and member communications related to the pharmacy program.
Track industry trends and regulatory changes and evaluate their effect on pharmacy contracts and services.
Provide on-site education and training to providers on formulary and pharmacy procedures.
Develop strategies with PBM partners to improve HEDIS ratings and other quality measures.
Participate in on-site visits to hospital systems, selected physician group practices, and pharmacies.
Serve as the main contact for physicians and plan staff experiencing pharmacy program problems, and for the State Agency’s pharmacy inquiries; respond to State inquiries in a timely manner.
Support oversight of the Fraud and Abuse program system; communicate suspected fraud identified by contact center staff and recommend action for providers whose patterns appear outside guidelines and accepted pharmacy standards.
Work with the PBM to ensure appropriate local provider and member outreach to improve program quality.
Coordinate with the line-of-business compliance team on operational and medication management issues identified through PBM oversight.
Identify line-of-business-specific cost-containment initiatives, recommend improvements, and coordinate initiatives with the PBM.
Develop relationships with local behavioral health providers, PerformCare staff, and the PBM to improve health care program delivery.
Foster teamwork, cooperation, respect, and diversity.
Collaborate with the PBM to create opportunities and efficiencies and improve value across the Enterprise.
Supervise and develop pharmacy technicians to support plan needs.
Perform other job-related duties as assigned.