Gateway Health Plan
Job Description :
This job supports the VP, Pharmacy in managing the overall Pharmacy program administration associated with the respective client portfolio as well as its P&L and contract compliance. Responsibilities include leading initiatives regarding the specific business line expense trends, cost efficiency strategies, contractual or programmatic changes, quality-of-care outcomes, customer service and other specific product related requirements. The incumbent also contributes to and executes on the strategic plan for his or her product. The incumbent requires a thorough understanding of all aspects of the pharmacy product.
- Create and maintain strategic partnerships with customers through the development and implementation of product business plans that result in long term retention of profitable relationships.
- Analyze key performance indicator reports, identify negative trend and opportunities for improvement, facilitate internal collaboration to develop and implement solutions, and continuously monitor results to assess the value of implemented initiatives.
- Lead product based pharmacy trend management discussions with internal partners including senior executives.
- Support contractual pharmacy-based risk-sharing arrangements, and provide industry and product specific Pharmacy insight for capitated rate negotiations and internal financial forecasting.
- Provide clinical expertise, and serve as an influential member of internal clinical and value-based evaluation committees that drive formulary and utilization management functions.
- Participate in product specific Pharmacy and Therapeutics Committees and Drug Utilization Review (DUR) Committees as necessary or contractually required.
- Participate in product specific State or government meetings as necessary.
- Coordinate implementation of clinical programs and operational requirements as necessary.
- Support product specific business retention and business development activities as necessary.
- Ensure that all contractual obligations including service level agreement (SLA) targets are achieved.
- Ensure that all related regulatory requirements are understood and followed.
- Other duties as assigned or requested.
- Bachelor of Science degree in pharmacy or Doctor of Pharmacy degree
- Active pharmacist license
- 4 years of experience in managed care pharmacy
- 2 years of clinical account management experience in Medicaid as part of the 4 year managed care experience
- 2 years of experience analyzing pharmaceutical cost of care data
- Masters of Pharmacy or Masters of Business Administration
- AMCP-ASHP accredited residency in managed care pharmacy
- Experience leading or participating in Pharmacy & Therapeutics committee
- Strong analytic capability with experience in executing on insightful quantitative and qualitative data findings
- Mix of clinical expertise combined with business acumen
- Demonstrated competency in identifying opportunities and communicating value-driven solutions
- Ability to think strategically, act urgently, and execute flawlessly
- Ability to establish strong, positive customer relationships
- Ability to lead and encourage others in collaborative problem solving
- Strong interpersonal and written communication skills
- Ability to prioritize multiple projects while successfully meeting all deadlines
- Familiarity with pharmacy benefit management processes or operations
SCOPE OF RESPONSIBILITY
Does this role supervise/manage other employees?
Is Travel Required?
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.
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