Pharmacy, Sr. Leader, Pharmacy Programs
Band level: Sr. Leader II
Status: Full-time, Exempt: Yes
Referral Bonus: Standard
Talent Acquisition Representative: Carolyn Vinci, CVinci@mvphealthcare.com
The Sr. Leader, Pharmacy Programs will be responsible for the oversight and coordination of the Pharmacy department programs to improve patient outcomes and manage the cost of pharmaceutical care.
Develop, implement, and manage clinical initiatives, including drug prior authorization and medication management programs, and monitor results of the programs to identify opportunities; present recommendations to Pharmacy and Therapeutics (P&T) committee and/or other customers. Provide clinical expertise and staff support to the P&T committee, including coordinating PBM participation; and query prescriber specialists as needed to obtain expert opinion on complex or controversial policies or issues. Evaluate utilization trends, cost drivers, program effectiveness, data reporting, data accuracy, and related issues using data supplied by the PBM, internal resources including medical claims systems, and/or PBM reporting programs for internal and VBP/IPA/client needs. In conjunction with Sr Leader of Pharmacy Management, provide data analysis and projected utilization and costs for all MVP Companies and in aggregate for appropriate action. Evaluate and identify inappropriate prescribing patterns from prescription and medical claims data for potential action by appropriate personnel. Continually evaluate existing processes for potential improvement. Provide direction and management for the Pharmacy department operations; supervise staff including selection, orientation, training, performance management, counseling, and corrective action as needed; handle policy and employee issues in conjunction with Human Resources; and develop and monitors staff performance and quality standards.
Assist the Sr. Leader, Pharmacy Management with the design of pharmacy programs and initiatives to maximize NCQA, HEDIS, QARR, and STARs outcomes, including managing and/or performing data acquisition, reporting, and analysis for NCQA, HEDIS, QARR, and STARs projects. Develop, implement, and evaluate interventions for pharmacy QI studies, including BHC meetings. Ensure pharmacy program compliance with NCQA guidelines and all MVP, local, state and federal regulatory
requirements. Assist Sr. Leader, Pharmacy Management in ongoing monitoring and auditing of PBM and other vendor compliance and performance; monitor communication regarding eligibility, benefits, claims payment, and prior approvals to ensure appropriate and timely benefit adjudication and service. In conjunction with the Sr. Leader, Pharmacy Management, assist with strategic planning, development, and implementation of departmental programs. Review and write department communications as needed.
Ability to maintain confidentiality and adhere to regulatory compliance issues as they exist and change from time to time. Ability to adapt to a fast-paced, changing environment. Maintains strict confidentiality in all areas of position. Ensures appropriate use of pharmacy data at MVP. Ability to deal with stressful situations in a calm and diplomatic manner. Performs other related duties as assigned.
BS degree in Pharmacy or Pharm. D
Current/eligible for Pharmacist licensure in the State of New York.
2-5 years in supervisory managed care pharmacy setting, OR 5 years in a managed care and/or PBM setting AND 2 years of direct supervisory experience.
Work experience in healthcare/health insurance or a statistical area required.
• PC literate; familiarity with word processing, downloading, database and Excel skills required (intermediate level)
• Strong written and verbal communications required.
• Ability to work in a team environment with internal and external staff, practitioners and members.
• Superior attention to detail and strong project management skills required.
MVP Health Care is an Affirmative Action/Equal Opportunity Employer (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at email@example.com.
- Job Family Pharmacy
- Pay Type Salary
- Headquarters Office, 625 State Street, Schenectady, New York, United States of America
- Rochester Office, 220 Alexander Street, Rochester, New York, United States of America