Skip To Content
Laptop
J203858

Director Specialty Pharmacy

Highmark Inc.

  • Company Highmark
  • Pittsburgh, PA
  • Pharmacy
  • Full time
  • Day (United States of America)

Company :

Highmark Inc.

Job Description : 

JOB SUMMARY

This job directs the Organization's specialty drug strategy across the medical and pharmacy benefits, to achieve cost savings and decrease the cost and utilization trends attributed to specialty drugs. Leads a highly matrixed team of business stakeholders that is collectively responsible for evaluating industry best practices for specialty drug management, identifying opportunities for enhanced management, evaluating possible solutions and driving approved solutions forward. Leads all strategic efforts related to specialty drugs working with the Organization's P&L's to understand how specialty spend is contributing to the market results and identifying strategies that drive market desired outcomes. This job is highly collaborative, and works closely with leaders across the health plan and within other business segments of Highmark Health such as HM Insurance Group, Highmark Health Solutions and Allegheny Health Network. Supports other business units that can contribute to specialty drug strategies including Clinical Services, Product/Network/Reimbursement and Medical Policy. Maintains external partnerships with pharmacy vendors and providers, where these entities play a role in helping to shape the Organization's specialty drug management strategy.  Ensures that the Organization's sales organization is well prepared to sell the Organization's specialty drug management solutions and programs. 

This role is looking for someone that has experience in implementing operational and strategic programs based off of complex healthcare (e.g., pharmacy) claim data analysis, and leading a healthcare analytics team.

ESSENTIAL RESPONSIBILITIES

  • Perform management responsibilities including, but not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.  Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
  • Direct strategy related to specialty drug management across the medical and pharmacy benefits and developing solutions for implementation. Develop and execute strategies aimed at addressing high cost drug spend associated with specialty drugs across the pharmacy and medical benefit.  This spend equates to over $2B and is growing exponentially.  It is one of the biggest drivers of the increase in pharmacy spending.  Strategies include product, network, benefit design, clinical management, contracting.
  • Lead a matrixed team of business stakeholders that is responsible for advancing specialty drug initiatives.
  • Support matrixed teams where specialty drug utilization has been identified as a contributing factor of targeted interventions 
  • Engage with pharmacy vendors and provider partners that have a role in specialty drug management solutions.
  • Other duties as assigned.

EDUCATION

Required

  • Bachelor's Degree in Pharmacy, Business Administration/Management or a Healthcare related field

Substitutions

  • None

Preferred

  • Master'Degree in Pharmacy (PharmD) or Business Administration/Management
  • Lean or Six Sigma Process Improvement Certification

EXPERIENCE

Required

  • 5 - 7 years in a Health Plan or PBM Payer Organization
  • 5 - 7 years in Management

To include

  • 3 - 5 years in Specialty Drug Manangement
  • 3 - 5 years in managing large, Cross Functional Team Projects

And

  • 3 - 5 years in Leadership

Preferred

  • None

LICENSES AND CERTIFICATIONS

Required

  • None

Preferred

  • Lean or Six Sigma Process Improvement Certification

SKILLS

  • Analytical and Logical Reasoning/Thinking
  • Problem Solving & Decision Making
  • Oral & Written Communication Skills
  • Management
  • Team Building

Language (Other than English)

None 

Travel Required

0%  - 25%


PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-Based

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Occasionally

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required 

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Rarely

Lifting: 25 to 50 pounds

Does Not Apply

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. 

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.

For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

California Consumer Privacy Act Employees, Contractors, and Applicants Notice


Thumbnail Join Talent Community@2X

Connect with a career that’s right for you.

Introduce yourself and we'll get in touch monthly to share career insights and company news.

Join Our Talent Community