This position is responsible for all aspects of pharmacy help desks, including coverage determinations, appeals and grievances, as well as operational oversight of the pharmacy benefit manager and all related downstream activities.
The Director, Pharmacy Operations will also work closely with leadership in areas of compliance and oversight to ensure ongoing compliance with all CMS guidance and regulations.
- Manages, supervises, sets performance goals/objectives, monitors performance, evaluates, and mentors clinical and non-clinical staff
- Develop and implement rigorous internal review and mock audit protocols in line with CMS and other external or internal compliance expectations.
- Manages all aspects of contracts with applicable vendors as well as monitors the performance of the vendor.
- Create, manage and maintain documentation, including but not limited to departmental policies and procedures, to support regulatory oversight.
- Participates in monitoring and reporting cost savings (ROI) related to coverage determination activities.
- Assists in the creation of various communications for distribution to internal and external customers.
- Prepares, reviews, and conducts presentations or educational programs to various audiences, including customers, agents, and internal marketing departments.
- Participates in development of annual departmental budget, monitors budget, and identifies budget discrepancies. Researches cause and makes recommendations.
- Support review and resolution of clinical and compliance grievances and appeals.
- Support clinical initiatives related to STAR measures.
- Adhere to Pharmacy Policies and Procedures
- Bachelor/ Honors(Bachelor Degree in any Discipline) completed.
Additional Academic Requirements
- Bachelor's degree in related field. Combinations of relevant education, certifications, and experience may be considered in lieu of a degree. Continuous learning, as defined by the Company’s learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.
Minimum 10 years of experience is required.
Additional Experience Requirements
- Ten years of progressively more responsible experience in a pharmacy benefit management environment with demonstrated technical experience that provides the necessary knowledge, skills and abilities. Seven years of leadership experience and direct oversight of a clinical pharmacy help desk environment with demonstrated technical knowledge that provides the necessary knowledge, skills, and abilities. Medicare Part D experience required. Prior experience with successfully managing CMS Medicare program audit required. Experience with pharmacy benefit manager (PBM) oversight required. Experience with vendor installations, specifically PBM and prior authorization vendor tools is preferred.
SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
- Thorough knowledge of applicable CMS regulations related Medicare pharmacy benefits.
- Decision making, organizational, and problem-solving skills.
- Excellent analytical skills.
- Proficient in current industry standard PC applications and systems (e.g., Word, Excel and PowerPoint).
- Must demonstrate leadership ability and team building skills to effectively supervise professional and non-professional staff and interact with all levels of management.
- Ability to work with and empower others on a collaborative basis to ensure success of unit team.
- Ability to effectively exchange information, in verbal or written form, by sharing ideas, reporting facts and other information, responding to questions and employing active listening techniques.
- Ability to effectively present budgetary and/or cost information and respond to questions as appropriate.
- Ability to establish workflows, manages multiple projects, and meets necessary deadlines
- Applicant should have experience of working in the following category(ies): Pharmacist
- Experience should include the following skills: Bank/Non-Bank Fin. institution
Application Deadline: 22 Jul 2022