Sr. Manager, Pharmacy Benefits
About The Position
The Sr. Manager, Pharmacy Benefits is responsible for the overall leadership & management of all pharmacy benefit plans. The Sr. Manager is responsible for oversight of the benefit, partnership with the PBM, providing guidance on regulatory changes, reviewing and leading responses for policy changes, and maintaining compliance with all Federal and State agencies. In addition, the Sr. Manager will maintain an aptitude for the Medicare Part D and the Medicare health plan business, considers Healthfirst’s position within the industry and assists in the development of a strategic direction of the organization as it relates to pharmacy benefits. The Sr. Manager will also maintain a well-functioning team that develops and maintains flawless Medicare pharmacy benefits for Healthfirst Medicare members.
Requirements
- Doctor of Pharmacy (PharmD) from an accredited institution
- Licensed Pharmacist in good standing
- Knowledge of regulations of the Centers for Medicare and Medicaid Services and the New York State Department of Health
- Knowledge of specialty pharmaceuticals and billing practices in the medical and pharmacy benefits
- Experience with pharmacy benefit management oversight including maintaining policies and procedures related to formulary design and utilization management processes
Nice To Haves
- A minimum of 2 years’ experience, overseeing a reputable Medicare, Medicaid, or Commercial Pharmacy Benefit Management program for a PBM or health plan
- Maintain an active National Certification for Pharmacy and/or Healthcare professionals
- PGY1 Managed Care Residency
- Eligible to practice pharmacy in the state of New York
Responsibilities
- Works collaboratively to design and manage the Healthfirst Pharmacy Benefit for all plans
- Strategically leads the development, planning and implementation of the annual pharmacy benefit cycle to ensure that pharmacy benefits are in-line with Healthfirst Product Strategy, PBM capabilities and regulatory timeframes
- Reviews and facilitates the response and/or the action plan for all applicable CMS memos and other notifications
- Collaborates with Pharmacy, Actuary, Finance, Medical Economics and Product teams to analyze and present monthly cost trends for all lines of business
- Partners with designated team members to develop, coordinate and manage drug related medical coverage policies
- Supports pharmacy leadership efforts to drive improvement of product quality goals
- Manages the Benefits team and works with others on the Pharmacy team to oversee administration and monitoring of pharmacy benefit operations along with oversight of the PBM
- Performs Utilization Management reviews of relevant drugs when necessary
- Assists in regulatory and compliance audits for all designated plans.
- Acts as pharmacy department liaison with vendors and regulatory organizations completing audits for applicable plans
- Completes all required company compliance standards required
- Additional duties as necessary
Benefits
- Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements).
- Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
Ph.D. or professional degree
