Virginia Medicaid Pharmacy Director

Humana

4d • Remote

About The Position

Become a part of our caring community and help us put health first The Clinical Pharmacist Lead monitors drug development pipeline, and medical literature, while providing clinical support for internal stakeholders. Utilizes broad understanding of managed care and PBM knowledge to develop, and/or implement strategies and programs to mitigate cost trend and improve health outcomes. The Clinical Pharmacist Lead works on problems of diverse scope and complexity ranging from moderate to substantial. The Pharmacy Director, internally known as a Clinical Pharmacy Lead, plans, directs, and monitors all financial, operational, professional, and clinical activities for the purposes of pharmacy program development for our Medicaid and Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) Virginia health plan. The individual leverages a broad understanding of managed care and pharmacy benefit management (PBM) to develop and implement strategies and programs that mitigate cost trends and improve health outcomes. They ensure the pharmacy department provides optimal pharmaceutical services that meet all legal, accreditation, and certification requirements. This position will coordinate day-to-day pharmacy operations directly with the plan Chief Executive Officer and Chief Medical Officer.

Requirements

• Bachelor’s degree in Pharmacy or Doctor of Pharmacy (PharmD)
• Must reside and have an active Pharmacist license with the Board of Pharmacy in Virginia.
• Minimum of ten plus years of Pharmacy Experience with at least three years’ experience in managed care and/or PBM operations
• Ability to travel 10% of time
• Successful track record in facilitating and consulting across teams and managing projects
• Thrives in a fast paced, multi-project work environment while still ensuring attention to detail
• Excellent communication skills, both oral and written
• Proficiency in Microsoft Word, Excel, & PowerPoint
• Expertise in working collaboratively and communicating with staff in different positions and all levels of management position
• Preference to candidates who currently live in or in the vicinity of Richmond, VA.

Nice To Haves

• Bachelor’s degree (or higher) in public health, Business Administration or a related field
• Board Certified Specialty Pharmacist
• Experience with Microsoft Access & Microsoft Project
• Experience with data analytics

Responsibilities

• Keeps current with State and Federal regulations regarding the practice of Pharmacy and implements changes as necessary to maintain compliance supporting both the business and public relations strategies.
• Develops corporate communications to be shared with senior leadership.
• Supports trend management by conducting analysis of drug spend, utilization, and/or approval scenarios.
• Advises executives to develop functional strategies (often segment specific) on matters of significance.
• Exercises independent judgment and decision making on complex issues regarding job duties and related tasks.
• Works under minimal supervision, using independent judgment requiring analysis of variable factors and determining the best course of action.
• Facilitates and consults across teams and managing projects working collaboratively and communicating with staff in different positions and all levels of management positions
• Manages the Virginia health plan relationship with our internal PBM, Humana Pharmacy Solutions ensuring compliance with programmatic requirements, such as claims processing, prior authorization, formulary management and clinical programming
• Represents Humana at all Pharmacy Medicaid meetings including those with the Virginia Department of Medical Assistance Services (DMAS)
• Develops, executes and manages National Medicaid Pharmacy programs as needed.

Benefits

• Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being.
• Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work.
• Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Number of Employees: 5,001-10,000 employees