Manager Pharmacy Programs
Location: Portland, Maine
Description: Martin's Point Health Care is looking of Manager Pharmacy Programs right now, this occupation will be ordered in Maine. Detailed specification about this occupation opportunity please give attention to these descriptions. Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015. Position Summary The position of Manager, Pharmacy Programs is responsible for oversight of Pharmacy Health Plan development, management and integration of clinical programs; management of plan pharmaceutical expenditures; and compliance with contractual and accreditation obligations. This position works very closely with the Manager, Medicare Part D and Health Plan Pharmacy Operations within the Pharmacy Administration team and collaboratively with several other departments across the organization, including Pharmacy Operations (retail and mail-order), the Martins Point Health Care practices and key health plan operations such as Health Management and Health Plan Operations. Job Description Key Outcomes: Works collaboratively with internal clinical departments (e.g. Health Management, MPHC Onsite Pharmacies, Delivery System) to build new models of pharmacy and medical integration to ensure coordination of care and enhance patient outcomes. Optimizes the way pharmaceuticals are utilized throughout the organization with respect to both clinical and cost effectiveness. Assesses current pharmacy benefits and provide expertise to internal departments and external stakeholders on benefit design. Coordinates and participates in the implementation and review of drug prior authorizations and other pharmacy Utilization Management (UM) activities for various product lines including approval and denial of authorizations based on approved criteria with a current, unrestricted license to practice pharmacy. Develops and maintains cost effective pharmacy programs utilizing formulary management to increase medication adherence, ensure appropriate member care. Analyzes clinical individual and population data, drug program data, and drug therapy data. Develops and assess metrics to evaluate program performance. Identify and implement industry best practices to optimize performance. Facilitates continuous communication and collaboration with MPHC-operated clinic-based and mail order pharmacies around pharmacy benefit changes, clinical programs, and program changes/updates. Provides clinical pharmacy support to MPHC operated pharmacies in conjunction with Health Plan Clinical Pharmacists. Ensures pharmacy compliance with all plan contract obligations and regulatory requirements. Ensures compliance with all applicable accreditation standards. Provides timely, constructive performance feedback and coaching to ensure staff members meet performance expectations. Serves as key member of necessary committees and or work groups to achieve required results. Develops, implements and ensures continuous quality improvement and process improvement to deliver effective and efficient programs and services Cultivates a continuous improvement mindset within the staff, encouraging creative problem solving and root-cause analysis Develops and manages health plan pharmacy budgets that align with MPHC strategic objectives. Education/Experience: Bachelor’s degree in Pharmacy or Pharm D required. License must be unrestricted to perform UM functions as described in Key Outcomes. At least 4 years of pharmacy experience in clinical pharmacy and pharmacy operations. Experience with clinical pharmacy programs development and maintenance PBM/HMO/managed care and or managed Medicare pharmacy experience required Valid, unrestricted, State of Maine Pharmacist License or ability to sit for licensure Supervisory/Management experience preferred Skills/Knowledge/Competencies (Behaviors): Expertise with Drug Utilization review and Formulary concepts Ability to manage, organize and prioritize work load in a timely accurate manner Ability to delegate responsibility, set priorities and establish accountability Excellent customer services skills Superior written and verbal communication skills Solid analytical skills and strong mathematical ability Knowledge of medical terminology and drug therapeutic classes Knowledge of PBM third party billing, pharmacy claims processing, and pharmacy data management Knowledge of clinical pharmacy programs and formulary management strategies Ability to reconcile financial reports and data Proficiency in Microsoft Office applications (Word, Excel, PowerPoint) Strong organizational skills (ability to prioritize and multi-task while maintaining focus on objectives). Strong interpersonal skills and the ability to collaborate with internal and external clients Ability to function independently with sound judgment in decision making Takes appropriate initiative while soliciting input/advice appropriately Ability to handle confidential and sensitive information in a discreet and professional manner. Demonstrates an understanding of and alignment with Martin’s Point Values. Do you have a question about careers at Martin’s Point Health Care? Contact us at: jobinquiries@martinspoint.org
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This occupation will be started on: Wed, 10 Jan 2018 22:09:17 GMT