Pharmacy Director

Company: RPMGlobal
Location: Baton Rouge
Posted on: August 7, 2022

Job Description:

Responsibilities:
The Director Pharmacy will manage direct reports with responsibility for supporting the following activities.

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• Monitor the following systems and programs for maximum effectiveness, efficiency and return on investment. Develop and implement, in collaboration with the PBM, new process improvements and programs, analyze and evaluate ongoing effectiveness, identify and implement enhancements:
  
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  • DTM - focus areas, tracking results, program enhancements
    
  • Pharmacy queue improvement
    
  • Care Gaps
    
  • PerformMax - information required and user roles
    
  • Ensures compliance with all applicable state requirements
    
    
    
  • Partners with and/or directs PBM in the development of innovative programmatic solutions to improve medication adherence and compliance. Works with appropriate corporate partners to ensure these programs are implemented across all applicable lines of business.
    
  • Reviews clinical/financial recommendations and strategies provided by the PBM's clinical pharmacists in order to determine feasibility and appropriateness and ensure flawless implementation of these initiatives. Monitors the initiatives to measure results.
    
  • Monitor pharmacy trends; make recommendation for process, product and program improvement; plan, implement and monitor changes.
    
  • Review pharmacy utilization reports generated by PBM, in coordination with PBM clinical team, in collaborative effort to improve quality and contain costs
    
  • 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 sponsored by the line of business; participate on the plans' P&T Committee.
    
  • Generates necessary provider and member communications related to the pharmacy program
    
  • Keep abreast of industry trends and regulatory changes in the pharmacy industry and evaluate their effect on pharmacy contracts and services.
    
  • Provide on-site education and training for the line of business's providers on formulary and pharmacy procedures.
    
  • Develop strategies, along with our PBM partners, to improve HEDIS ratings and other quality measures.
    
  • Ensures compliance to NCQA accreditation standards
    
  • Participate in on-site visits to hospital systems and selected physician group practices and pharmacies.
    
  • Act as the main point of contact for physicians and plan staff who are experiencing problems with the pharmacy program (decision, process, timeliness, etc.).
    
  • Act as the main point of contact for the State Agency and responds to all pharmacy inquiries in a timely manner
    
  • Supports Fraud and Abuse program system oversight. Communicates any suspected fraud discovered by the contact center staff. Recommends course of action for providers where patterns appear outside of guidelines and generally accepted pharmacy standards.
    
  • Provide on-site consultation and education to nurses, case managers and/or physicians.
    
  • Work closely with PBM to ensure appropriate provider/member outreach is made at local level to improve overall program quality.
    
  • Coordinates with line of business's compliance team on key operational and medication management issues identified through plan oversight and monitoring of PBM.
    
  • Identify cost containment initiatives specific to line of business; make recommendations and offer program improvements; coordinate initiatives with PBM.
    
  • Develop/build relationships with the local behavioral health providers, PerformCare staff, and PBM with the goal of improving the delivery of health care programs.
    
  • Create and support an environment which fosters teamwork, cooperation, respect and diversity.
    
  • Collaborate and coordinate with PBM to create opportunities and efficiencies and improve and create value within the Enterprise.
    
  • Supervise and develop pharmacy technicians to support the plan's needs
    
  • Perform other job-related duties, as assigned
    
    Education/Experience:
    
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    • Registered Pharmacist with a current, active, unrestricted pharmacist license in Louisiana..
      
    • Minimum of three working years of Medicaid pharmacy benefits management and/or Managed Care Organization experience,
      
    • Experience with Claims Processing System [i.e SS&C, Argus, Darwin, Abarcs)
      
    • Proficiency with Microsoft Office Applications (Word, Excel, Outlook).
      
      NOTE:AmeriHealth Caritas utilizes a hybrid work environment with associates working from home three days a week, and in the office two days a week [Tuesday and Wednesday].The functions of this position will be performed onsite at our offices located at 10000 PerKins Rowe, Baton Rouge, LA 70810.

Keywords: RPMGlobal, Baton Rouge , Pharmacy Director, Executive , Baton Rouge, Louisiana