Senior Director Pharmacy Services / Job Req 772073092

PRINCIPAL RESPONSIBILITIES:

Responsibilities include the development of pharmacy cost containment strategies, oversight of the pharmacy services and vendors, monitor formulary & benefit management, and pharmaceutical programs & initiatives.

The Senior Director, Pharmacy Services is responsible for providing pharmacy expertise relative to pharmaceuticals.

The Senior Director, Pharmacy Services acts as a subject matter expert to internal departments, Senior Management, Governing Board members, and the Pharmacy and Therapeutics Committee (P&T).

The Senior Director, Pharmacy Services, leads the Pharmacy Services staff.

This is a hybrid position with expectations to attend in-person meetings, as requested.

ESSENTIAL FUNCTIONS OF THE JOB

• Function as the authoritative source of relevant and current information on all pharmaceuticals' efficacy, safety, comparative efficacy, cost, and cost impact.
• Oversee all levels of pharmaceutical information and/or education, in a proactive and timely manner to internal staff, members and providers.
• Oversee policies and procedures, systems and processes to assure compliance with all federal and state regulatory requirements pertaining to Formulary and benefit management.
• Co-chair the Pharmacy & Therapeutics (P&T) and P & T Subcommittee.
• Provide leadership, vision, training and short and long-term planning for Pharmacy services and staff
• Oversee the pharmacy prior authorization, physician administered drugs pass thru pharmacy, and pharmacy appeal process to meet the regulatory and contractual requirements with federal and state government agencies, including CMS and DHCS.
• Monitor, research, recommend and contract with vendors and implement programs related to pharmaceuticals include but not limited to PBM, Specialty pharmacy, formulary and benefits, drug utilization, medication therapy management, medication reconciliation, a rebate administrator and/or other relevant vendors.
• Monitor contract, performance and annual audits on delegated vendors.
• Provide leadership in audits conducted by a government agency in the area of pharmacy services.
• Identify trends and patterns in pharmaceuticals utilization.
• Develop provider and member programs to improve medication prescribing patterns and to increase patient compliance and adherence for improving quality measures.
• Negotiate contracts related to Pharmacy Services.
• Represent Pharmacy Services at meetings and committees concerning pharmacy performance and program status (internal and external [local and state]).
• Perform writing, reporting, administration, and analysis
• Recruit, interview, hire and conduct employee disciplinary actions and performance evaluation for direct reports.
• Comply with the organization's Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.
• Complete other duties and special projects as assigned.
• Develop criteria, clinical protocols, and analyze trends to recommend policy, program, and practice changes to achieve outstanding utilization results.
• Assist in the development of an overall strategic direction of the D-SNP line of business
• Participate in the Health Equity Improvement Committee, D-SNP quality sub-committee, Pharmacy and Therapeutics Committee, Peer Review & Credentialing Committees as well as work with ad-hoc physician and provider committees.
• Participate in the Board of Governors meetings, as requested
• Encourage and educate providers to effectively manage the delivery of health care and Alliance members to use the delivery network effectively and appropriately.
• Educate and train staff as needed
• Lead efforts to achieve outstanding HEDIS, CAHPS and STARS results.
• Ensure that medical decisions are rendered by qualified medical personnel, unhindered by fiscal or administrative management.
• Lead efforts to meet D-SNP regulatory requirements and accreditation standards.

PHYSICAL REQUIREMENTS

• Frequent sitting, walking, standing and lifting of folders and various objects weighing between 0 and 20 lbs.
• Frequent use of keyboard, mouse, and/or telephone headset.
• Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
• Occasional driving of automobiles.
• Possible air travel.

Number of Employees Supervised: 8-10

MINIMUM QUALIFICATIONS:

EDUCATION OR TRAINING EQUIVALENT TO:

• A graduate of an accredited School of Pharmacy with PharmD degree.
• Licensed and in good standing with the CA State Board of Pharmacy.
• D. residency preferred.
• MBA preferred.

MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:

• Ten years of experience in Pharmacy
• Seven years of managed care Pharmacy setting with experience of government sponsored programs, such as Medi-Cal and Medicare Part D.
• Five years of leadership experience.

SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):

• Excellent communication skills.
• Extensive knowledge of the California Medi-Cal and D-SNP programs
• Experience in budgeting and contract negotiation.
• Experience in PBM, health plan, hospital and retail pharmacy setting.
• Proficiency in Microsoft Office suites and reporting tools.
• Experience in DHCS, DMHC, NCQA and CMS pharmacy audits.

SALARY RANGE: $193,980.80 - $290,971.20 ANNUALLY

The Alliance is an equal opportunity employer and makes employment decisions on the basis of qualifications and merit. We strive to have the best qualified person in every job. Our policy prohibits unlawful discrimination based on race, color, creed, gender, religion, veteran status, marital status, registered domestic partner status, age, national origin or ancestry, physical or mental disability, medical condition, genetic characteristic, sexual orientation, gender identity or expression, or any other consideration made unlawful by federal, state, or local laws. M/F/Vets/Disabled.