[Hiring] Pharmacy Director @Amerihealth Caritas

Role Description

The Pharmacy Director will serve as the market pharmacy subject matter expert, collaborating daily with internal departments and the PBM while managing requests from State regulators. As a key member of the plan’s management team, this role will oversee the clinical and operational aspects of the pharmacy benefit, with a focus on improving outcomes and providing cost-effective care for Medical Assistance members enrolled in the Pennsylvania HealthChoices program.

This is a remote position; however, candidates must reside in Pennsylvania to meet contractual requirements.

Responsibilities

• Monitor systems and programs for maximum effectiveness, efficiency, and return on investment.
• Develop and implement new process improvements and programs in collaboration with the PBM.
• Ensure compliance with all applicable state requirements.
• Provide plan-specific Pharmacy SME support as needed by local plan and/or corporate projects.
• Partner with and/or direct PBM in the development of innovative programmatic solutions to improve medication adherence and compliance.
• Review clinical/financial recommendations and strategies provided by the PBM’s clinical pharmacists.
• Monitor pharmacy trends; recommend process, product, and program improvement.
• Review pharmacy utilization reports generated by PBM in coordination with the PBM clinical team.
• Support medical management goals by being a point person for the implementation of all pharmacy-related clinical programs and initiatives.
• Work with PBM to identify and resolve any operational issues.
• Provide support and attend all pharmacy-related meetings and committees.
• Generate necessary provider and member communications related to the pharmacy program.
• Keep abreast of industry trends and regulatory changes in the pharmacy industry.
• Provide on-site education and training for Providers on formulary and pharmacy procedures.
• Develop strategies to improve HEDIS ratings and other quality measures.
• Ensure compliance with NCQA accreditation standards.
• Participate in on-site visits to hospital systems, selected physician group practices, and pharmacies.
• Act as the main point of contact for physicians and plan staff experiencing problems with the pharmacy program.
• Act as the main point of contact for the State Agency and respond to all pharmacy inquiries.
• Support the Fraud and Abuse program system oversight.
• Communicate any suspected fraud discovered by the contact center staff.
• Work closely with PBM to ensure appropriate provider/member outreach.
• Coordinate with a line of business’s compliance team on key operational and medication management issues.
• Identify cost containment initiatives specific to line of business; make recommendations and offer program improvements.
• Develop/build relationships with local behavioral health providers, PerformCare staff, and PBM.
• Create and support an environment that fosters teamwork, cooperation, respect, and diversity.
• Collaborate and coordinate with PBM to create opportunities and efficiencies.
• Supervise and develop pharmacy technicians to support the plan’s needs.
• Perform other job-related duties, as assigned.

Qualifications

• Pharm.D. required.
• Registered Pharmacist with a current, active, unrestricted Pharmacist license in Pennsylvania.
• Minimum of three (3) working years of Medicaid pharmacy benefits management experience required.

Requirements

• Highly effective communicator able to establish relationships within and across departments.
• Highly organized and responsive to a challenging environment that may require urgent turnaround times.
• Innovative and Strategic Thinker.

Benefits

• Flexible work solutions including remote options and hybrid work schedules.
• Competitive pay.
• Paid Time Off (PTO) including holidays and volunteer events.
• Health insurance coverage for you and your dependents on Day 1.
• 401(k).
• Tuition reimbursement.
• And more.

Company Description

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs.

AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most.

Discover more about us at www.amerihealthcaritas.com .