Search Page | Back to Results

Director, Pharmacy

Position Summary
Provides Clinical Pharmacological leadership to the health plan, membership and provider network. Provides oversight for pharmacy and therapeutic issues, and ensures compliance with pertinent government regulations and standards.

Essential Functions/Responsibilities:
Operations
a. Ensures efficient operation of all pharmacy functions.
b. Oversees the pharmacy benefit for each plan product line, formulary development and management.
c. Reviews member, physician, pharmacy and drug utilization reports, identifying trends affecting the pharmacy budget.
d. Ensures detailed policies and procedures and standard operating procedures for pharmacy operations.

Government Program, Commercial and Regulatory Compliance
a. Maintains current knowledge of Government program regulations by participating in pharmacy related CMS calls and reading released guidance and implementing changes to maintain compliance.
b. Responsible for pharmacy related regulatory compliance.
c. Provides oversight for drug coverage determinations, appeals and pharmacy related grievances.
d. Participates in audits.

Clinical
a. In collaboration with key stakeholders, development of the clinical initiatives for members and providers (e.g., Quality, Utilization Management, Care Management).
b. Monitor, evaluate, develop and implement pharmacy specific initiatives (ie. DUR programs) and drug cost management strategies as appropriate.
c. Responsible for submission of clinical pharmacy related HEDIS, NCQA and government program material.
d. Recommend and implement appropriate actions and educational programs to influence prescribers.
e. Ensure systems are in place to monitor results.

Vendor Management
a. Oversight of all pharmacy related services provided by external vendors.
b. Oversees plans relationship with PBM to ensure optimum and market-competitive PBM services, formulary management, rebate generation and clinical programs.

Administrative & Other
a. Responsible for staffing, training and mentoring.
b. Ensure Providers have needed information regarding the pharmacy benefit.
c. Participate in business and budget planning process.
d. Serve as the pharmacy expert on a variety of committees and workgroups (ie. Quality Management).
e. Foster strong relations and work collaboratively with internal departments and external providers.
f. Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies

Minimum Qualifications

• Must be a Registered Pharmacist in the state of Maine
• Advanced Degree or may substitute with five or more years of like experience.
• Five or more years performing same or similar responsibilities. Relevant experience includes working in Pharmacy Benefit Management.

Skills and Abilities
• Independent judgment, decision-making, problem solving related to strategic planning and technical systems that affect the overall direction of the company.

Communication
• Ability to communicate complex information verbally and in written form to include policies and procedures, financial, legal, and/or technical documents, and opinion papers.
• Ability to provide guidance required to implement strategic programs and projects.
• Ability to supervise work within and/or across departments.
• Ability to negotiate and persuade professionals, board members and the general public.

Analytical
• Designing, developing, and implementing highly complex programs, products, technical systems, and policies that affect overall direction of the company.
• Requires excellent attention to detail.

Other Skills and Abilities
• Demonstrate strong leadership and managerial skills.
• Make sound decisions and recommendations based on consideration of facts, priorities, resources, and alternatives.
• Organize and manage time to accurately complete tasks within designated time frames in fast-paced environment.
• Maintain current knowledge of and comply with regulatory and company policies & procedures.
• Maintain confidentiality of patient and business information.
• Flexibility to adjust work hours to meet business demands.

KEY COMPETENCIES
People within Community Health Options are expected to work with integrity, humility, strategic vision, curiosity, and discipline. They must be self-motivated professionals, highly effective and compassionate communicators, effectively working with people, work processes, and actively engaging in continuous process improvement.

Reports to: Chief Medical Officer

Time:  Full time
Salary:  Salary
Category:  Clinical/pharmacy/quality

Updated: 4/27/2018 3:32:20 PM