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Director Pharmacy Services

Job Title:
DIRECTOR PHARMACY SVCS - PCHP
Reports To: Chief Medical Officer
Job Code: 4200
Direct Reports: Yes
Exempt: Yes

Mission
Excellent care for life

Vision
To be the most trusted provider of innovative healthcare

Values
Patient Centered Care
Drive for Excellence
Integrity & Respect
Teamwork

Standards of Behavior
Centra employees are expected to model the Standards of Behavior below.
Commitment to Patients & Visitors
• Serve with compassion.
• Communicate with clarity.
• Create a connection.
• Show Integrity.

Commitment to Colleagues
• Exceed expectations.
• Lead by example.
• Be dependable.
• Build ONE team.

General Summary
Provides comprehensive management and leadership for PCHP Pharmacy Department. Manages the PCHP pharmacy benefit for all client product lines. This includes oversight of the pharmaceutical prior authorization process, pharmaceutical appeal and grievance process, formulary management, regulatory compliance, and relationships with pharmaceutical companies including contracting for rebates. Provides comprehensive management of high-cost specialty pharmaceuticals. Oversight of clinical programs and services offered by the department including medication therapy management, educational programs for members, providers and PCHP/Centra staff. Working closely with the executive team of PCHP and the department of Medical Management to oversee the integration of clinical pharmacy program to support the success of key medical cost initiatives including but not limited to case management, inpatient and outpatient utilization management, disease management and quality management. Provides pharmacy leadership, strategy and overall management of all pharmacy initiatives within PCHP. Supports the success in pharmacy initiatives with PCHP and its contracted systems. The scope of the position encompasses support of all care delivery venues of the company including acute as well as non-acute settings accountable to the PCHP Board for financial and clinical success for all PCHP pharmacy initiatives.

Principle Duties and Responsibilities – Essential Functions
Title and Definition

Provide leadership and strategic vision to manage the development of clinical pharmacy services provided by PCHP. Ensures efficient, high quality, accurate and cost-effective patient-focused pharmaceutical care.

Oversees pharmacy efforts to enhance patient outcomes through improvement in use of drug therapy for PCHP.

Oversees the establishment and implementation of clinical pharmacy programs with the Director of Medical Management. Develop pharmacist role in the integrated care model/disease management programs. Serves as a consultant in the development of Disease Management Pathways. Including the development of educational programs for members to enhance knowledge, compliance and cost.

Provides and maintains effective communications with providers in the Centra healthcare system, the community and all levels of leadership staff.

Develops department plans, goals around the budget and monitors adherence to the goals developed with management team.

Selects and gives guidance to management team. With the pharmacy management team develops standards of performance, summarizes evaluation of performance and initiates necessary personnel actions.

Develop appropriate pharmacy departmental staffing ratios, and coordinate the hiring, training, and development of all departmental personnel.

Oversight of operational issues as related to pharmacy claims processing, retail pharmacy network development, mail service and specialty pharmaceutical distribution.

Serves as liaison with PCHP PBM to ensure effective implementation of the PBM contract.

Oversee the development and maintenance of the client’s formulary process including pharmacy prior authorization systems and procedures.

Ensure optimization of all pharmaceutical bids and contracts and drug purchase rebate opportunities.

In conjunction with the Director of Medical Management provides Oversight of the development of Drug Utilization Review, Medication Safety, and Quality Assurance activities designed to ensure rational, safe and cost-effective drug therapy for all enrolled members of the organization.

Provide support and necessary representation on all legal, regulatory and compliance issues as they affect the practice of pharmacy throughout the company including URAC/NCQA accreditation standards. This includes development, maintenance and education for pharmacy policy and procedures.

Work closely with Medical Affairs/Directors and other departments on behalf of clinical and member/patient issues. Participates in interdepartmental communications and committee activities as needed.

Evaluate emerging health care management technologies (i.e., e-prescribing tools) to the extent that they support the strategic goals and objectives of the company.

Participate in the development of pharmacy benefit design and pharmacy benefit underwriting.

Participate in the design and implementation of new products and services of value to the company.

Has management responsibilities for the PCHP Pharmacy Department staff, when applicable and accountability for the performance of the department.

Initiates and follows through with the annual strategic planning process which includes the development of all strategic objectives and tasks for the department, creation and implementation of written work plans for all major tasks, and tracking to insure maintenance of timelines for completion of the tasks.

Responsible for tracking and trending all Pharmacy department measures and communicates such to senior leadership at least quarterly, including recommendations for interventions on any areas not meeting expectations or goals.

Evaluates per member per month costs for plan costs for Pharmacy, including self-administered and office administered specialty pharmaceuticals. Develops innovative mechanism to favorably affect these costs while maintaining and improving quality of care.

Functions as the Pharmacy Department lead in interactions with other PCHP departments to provide assistance with their functions including marketing, enrollment, provider services, and other functions as indicated.

Serves as the liaison between the PCHP Pharmacy Department and external organizations such as state medical societies, pharmacy organizations, DOI, HSD, CMS and other, MCOs to promote the best interests of PCHP. Including representing PCHP’s pharmacy interest in local, state and national meetings.

Provides pharmacy leadership and overall management of all pharmacy initiatives within PCHP and supports the success in pharmacy initiatives within the PCHP enterprise in conjunction with other pharmacy directors in the system.

Develops and maintains current knowledge of national trends in pharmacy, general healthcare trends, current and emerging market forces and regulatory and legislative initiatives.

May perform other duties as assigned or requested and job specification can be modified or updated at any time.


Required Education (Degree / Diploma - Program)
Educational Requirements:
Doctorate degree in Pharmacy (PharmD)

Preferred Education (Degree / Diploma - Program)
Educational Requirements:

Required Experience (Years of Experience / Type of Experience)
Experience Requirements:
Seven to ten years pharmacy management.
Extensive clinical and executive level management experience.
Managed care residency or equivalent managed care certificate programs or experience.
Requires detailed knowledge of pharmacy (HMO, hospital, retail, and specialty) in terms of theories and practices to serve as the resource or educator to other practitioners in the healthcare system. This staff member must demonstrate knowledge of the principles of growth and development over the life span of patients served.

Preferred Experience (Years of Experience / Type of Experience)
Experience Requirements:
Required Certification & Licensures
Certification / License
Certification/Licensure Requirements
Virginia Board of Pharmacy License required.
Preferred Certification & Licensures
Certification / License
Certification/Licensure Requirements

Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

Centra will engage in the interactive process to determine if reasonable accommodations can be made to enable individuals with disabilities to perform the essential functions of their jobs.

On-the-job time spent in the following physical activities. The amount of time spent is indicated in the appropriate boxes below:
Stands, Walks or Sits - Occasionally up to 1/3 of the time, Frequently from 1/3 to 2/3 of the time and/or Constantly greater than 2/3 or more of the time on the job to complete essential job duties.
Uses hands to finger, handle, feel to - Grip, handle and feel constantly
Reach with hands and arms - Constantly
Stoop, kneel, crouch, crawl - Occasionally up to 1/3 of the time, Frequently from 1/3 to 2/3 of the time and/or Constantly greater than 2/3 or more of the time on the job to complete essential job duties.
Forward Bending - Occasionally up to 1/3 of the time, Frequently from 1/3 to 2/3 of the time and/or Constantly greater than 2/3 or more of the time on the job to complete essential job duties.
Climb stairs - Occasionally up to 1/3 of the time, Frequently from 1/3 to 2/3 of the time and/or Constantly greater than 2/3 or more of the time on the job to complete essential job duties.
Climb ladder - Occasionally up to 1/3 of the time, Frequently from 1/3 to 2/3 of the time and/or Constantly greater than 2/3 or more of the time on the job to complete essential job duties.

Weight Demands (Activity / Frequency)
Lift/Carry up to 10 lbs - Occasionally - Up to 1/3 of the time
Lift/Carry up to 25 lbs -
Lift//Carry up to 50 lbs -
Lift/Carry up to 100 lbs * -
Lift/Carry more than 100 lbs * -
* Only with Assistance

Specific Demands Not Listed

Vision Requirements:
Close Vision - clear vision at 20 inches or less
Distance Vision - clear vision at 20 feet or more
Color Vision - able to identify and distinguish colors (if applicable)

Hearing Requirements
Equipment Alarms - Ability to hear equipment alarms
Instructions - Ability to hear instructions from physician and staff
Patients - Ability to hear patient call

Noise Level
Noise Level

Work Environment
Some positions may entail the following work environments:
Wet, humid (non-weather)
Extreme cold (non-weather)
Extreme heat (non-weather)
Outdoor conditions
Near moving mechanical parts
Fumes/air borne particles
Toxic/caustic chemicals
Risk of electric shock
If these environments are a factor of your work environment characteristics, they will be considered an essential function of this job.

Disclaimer Statement
The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required of personnel so classified.

Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

Time:  Full time
Salary:  Salary
Category:  Operations

Updated: 1/22/2021 10:23:22 AM