Remote - Director of Clinical Pharmacy

3 days left

HealthCare Recruiters International
San Mateo County, California, US
Jun 28, 2021
Aug 01, 2021
Position Type
Specialty Area
Work Setting
Health System

This encompasses but not limited to the following pharmacy management services across prescription and medical benefits

The Director of Clinical Impact will serve as a pharmacist subject matter expert (SME) to support and deliver Company's commitments for clinical products and services to clients.

Formulary, utilization management programs and outcome measures.

Development and implementation of clinical pathways.

Pharmacy and Therapeutic Committee and coverage policy strategy, development, and support.

Pharmaceutical Pipeline Tracking/MonitoringFederal and State legislation and compliance, including but not limited to Commercial/Exchange, Medicare D, Retiree Drug Subsidy Programs, and Medicaid.

Drug program analysis and modeling, including but not limited to trends, costs savings/ROI, benchmarking, forecasting, and other related reporting.

Supporting RFPs for pharmacy benefit management or other services provided by vendors.

  • Serve as a SME in delivering pharmacy benefit management services for Company's clients across prescription and medical benefits for services described in Position Summary above.
  • Manage and partner with Company's support vendors to maintain current and custom clinical products, including formulary and utilization management programs.
  • Support product growth by developing innovative pharmacy benefit products and services.
  • Ensure products, programs and services provided are consistent with best practice approaches and in compliance with State/Federal requirements, as applicable (e.g., Formulary, Clinical programs, Medication Therapy Management, STARs, Hedis, etc.).
  • Partner with Company's Finance, Underwriting and Analytics staff to review, interpret, and provide commentary, recommendations, and forecast medication costs for Company clients.
  • Provide pharmacy insight and knowledge of key industry trends, product pipelines, specialty medications at both pharmacy and medical benefit channels, formulary and utilization management strategies, and other pharmacy product innovations to Company staff and downstream to clients.
  • Collaborate with the Analytics team, develop and innovate outcomes-driven medication management programs and products, present "Best in Class" solutions and clinical advisory services for Company clients.
  • Provide level of services that is appropriate for client-specific time zones and hours of operation.
  • Ad hoc analyses and projects as requested by Company or Company Clients.
  • Passion for improving clinical outcomes, critical thinker, willing to challenge the status quo.
  • A minimum of five (5) years experience as a pharmacy manager or minimum of two (2) years experience as a pharmacy director in a health plan(s) with direct, hands-on experience with formulary and utilization management programs (clinical review/analysis, P & T Committee support, and utilization management program development and implementation), pharmacy benefit management operations, pharmacy and medical benefit claims analysis, implementation of pharmacy program solutions, and measuring impact/performance.
  • D. required, residency and/or board certification preferred.
  • Knowledge of working within a PBM / Healthcare business model, primarily around clinical programs, specialty pharmacy, and formulary/utilization management.
  • Experience with Medispan nomenclature in developing and structuring coding logic necessary for implementation, maintenance, oversight and reporting of clinical service offerings (e.g., formulary, prior authorization, and step therapy).
  • Experience in creating/developing prior authorization decision trees to support electronic PA, (such as MedHok).
  • Experience is analyzing medical benefit drugs and associated services under the medical benefit, based on HCPCS and diagnostic codes.