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J204125

Manager Pharmacy Services

Highmark Wholecare

  • Company April 2022 Ed (1)
  • Home, PA
  • Pharmacy
  • Full time
  • Day (United States of America)

Company :

Highmark Wholecare

Job Description : 

JOB SUMMARY

This job supports the director of pharmacy services in key activities pertinent to budgetary objectives, operational service levels, compliance outcome measures and business partner relationships necessary to achieve and sustain performance standards relevant to the success of departmental and Company strategic goals/initiatives.  The incumbent is  responsible for establishing, directing, sustaining and managing a clinical pharmacy services program component within the pharmacy that will foster clinical intervention and outreach across departmental divisions to achieve measurable outcomes leading to the enhancement of quality care delivery.       

ESSENTIAL RESPONSIBILITIES

  • Serve as second in command of the pharmacy department and its services in this capacity. Fully in charge of the pharmacy department and its services in the absence of the pharmacy director.
  • Provide managerial insight and expertise to assist the pharmacy director in attaining positive budgetary, operational and compliance measures and business partner relationships as requested/required. Key components of these measurements/relationships are to include: formulary and benefit design oversight; budgetary, regulatory and NCQA compliance; PBM intervention; operations service indicators; P&T Committee participation; departmental staff education/development.
  • Design, develop and manage a clinical services program component of the pharmacy department. Key elements of this program to include:  management of clinical pharmacist staff complement; oversight of the Medication Therapy Management program, clinical framework design of drug benefit offering across multiple lines of business; establishment of drug utilization review programs/development of prior authorization protocols/safety and management edits to drive positive quality outcomes tied to cost effective drug therapy treatments.
  • Integrate clinically focused pharmaceutical practice standards into the philosophies of the Company Prospective Care Management (PCM®) business model. 
  • Serve as department liaison functioning as PCM® business model educator for the department while providing interdepartmental clinical expertise/ program development sufficient to sustain a clinical pharmacy presence within the confines of the PCM® care model profile.  
  • Design, develop and implement clinical/quality driven initiatives consistent with the departmental and/or Company strategic/tactical plan. Initiatives will include those quality driven measures offering financial incentive linked to outcomes benchmarked against HEDIS, risk scores, Star ratings, Pay for Performance (PFP) and other related quality scores.
  • Serve as liaison for directing/participating in interdepartmental initiatives requiring pharmaceutical clinical intervention to impact performance improvement/quality driven measures.      
  • Direct the development, implementation and continuous improvement of the pharmacy benefit across multiple lines of business to deliver quality health care through appropriate and cost-effective drug utilization. 
  • Assist in analyzing and structuring strategic opportunities within the benefit design.
  • Identify and conduct risk assessment as needed based upon ongoing monitoring of pharmacy data. 
  • Other duties as assigned or requested.

QUALIFICATIONS

Minimum

  • Bachelor of Science degree in pharmacy or Pharm D
  • Active Pennsylvania pharmacy license
  • 5 years of experience as a registered pharmacist
  • 3 years of management experience, or applicable advanced health science/business degree, or work experience equivalent
  • Experience in managing drug expenditures/utilizing cost reduction techniques
  • Clinical practice experience/evidence based decision making
  • Strong communication and organizational skills
  • Working knowledge of information systems such as Microsoft Outlook, Word, Excel

Preferred

  • 3 years of previous experience working within a pharmacy managed care setting
  • Understanding of the pharmacy benefit management (PBM) practice/process
  • 3 years of experience in a Medicare Part D managed care setting
  • 3 years of experience in a Medicaid Managed care setting

Skills 

  • None

SCOPE OF RESPONSIBILITY

Does this role supervise/manage other employees?         

Yes   

WORK ENVIRONMENT

Is Travel Required?

Yes  

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 position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies

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 )

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

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