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Who We Are

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health (https://www.point32health.org/) .

Job Summary

Under the direction of the Director, Clinical Pharmacy Operations, the Senior Manager, Clinical Pharmacy Operations is responsible for managing a team focused on the execution of clinical pharmacy programs and strategies to mitigate cost, improve adherence, and maintain affordability. Leads the implementation and maintenance of evidenced based, cost-effective program for all lines of business in all market segments. Guides clinical pharmacy team in the implementation of clinical programs, aligned with enterprise goals, including medical cost reduction and administrative simplification for members and providers. Ensures compliance with state and federal regulatory and accreditation requirements in all geographies. Collaborates with PBM to optimize member experience and clinical outcomes. Directs support functions for the Pharmacy and Therapeutic’s committee in collaboration with the pharmacy medical director. Leads and manages the work of the clinical pharmacy team, effectively delegating as appropriate and holding team members accountable for meeting deliverables and achieving results. Sets priorities and ensures that the key deliverables of the team stay on track.

Job Description

Key Responsibilities/Duties** **– what you will be doing** (top five) **:

+ Lead the maintenance of enterprise formularies and pharmacy programs, for all lines of business and geographies. Lead the annual review of all formularies and clinical pharmacy strategies, including a competitive analysis, cost-benefit review of programs, and trend review by therapeutic class. Work with Pharmacy Benefit Manager (PBM) to monitor pharmacy spend and performance to identify opportunities for improved management. Ensure formulary management activities meet state and federal requirements.

+ Identify initiatives for medical cost reduction, administrative cost reduction and/or market competitiveness. Lead the business evaluation and implementation through collaboration and communication with other departments and stakeholders and Pharmacy TCOC (Total Cost of Care) team.

+ Represent clinical pharmacy interests at inter-departmental meetings and on project teams. Identify implications for Pharmacy Services department and facilitates/coordinates follow-up with others in the department. Disseminate information and provides periodic updates as needed.

+ Hire, train, supervise and evaluate the activities of the Clinical Pharmacy Team staff. Provide coaching, feedback, and direction to staff to insure the successful achievement of their goals and that of Point32Health. Prioritize projects and initiatives and support staff in the resolution of escalated issues. Serve as a role model for staff and foster a collaborative and team-based approach both within the Department and interdepartmentally. Effectively manage change and constant prioritization based on strategic and operating goals

+ Direct the research and analysis of identified problems and issues, the validation of findings and the development and communication of plans for problem resolution. Support staff in the identification and verification of problems and provide guidance in the development and implementation of appropriate solutions. Identify for the Director those issues of broader complexity and/or sensitivity which may require action by the Director and recommend solutions for those issues having broader complexity or ramifications.

+ Participate in and/or lead departmental and interdepartmental meetings, including but not limited to Pharmacy & Therapeutics Committee, Drug Coverage Committee, Specialty Pharmacy committees, and Pharmacy Compliance.

+ Oversees team compliance with all federal and state laws and accrediting bodies and keep abreast of marketplace developments and regulatory and licensing requirements as it relates to Clinical Pharmacy and formulary management.

+ Other duties and projects as assigned.

Qualifications** **– what you need to perform the job

Certification and Licensure

+ Licensed health care professional (e.g., PharmD, RPh or RN) with current unrestricted license in state of residence.

Education

+ Required (minimum): BS in Nursing, Doctorate degree in Pharmacy (PharmD), or Registered Pharmacist (RPh)

+ Preferred: Master’s degree in business and/or health policy

Experience

+ Required (minimum): 8-10 years’ to include 6 years’ related experience in pharmacy, and 2 years of supervisory experience.

+ Preferred: 1 - 2 years’ managed care or PBM work experience. Experience supervising in an office or clinical environment is desirable. Experience with multiple lines of business such as commercial, Medicare and Medicaid are desirable. Expertise in business process changes and leading people is also desirable.

Skill Requirements

+ Strong verbal and written communication skills

+ Work cooperatively as a team member across multiple levels within the organization

+ Results orientation - strives to meet business goals

+ Critical and Analytic thinking – must understand cause and effect, internal and external impact of business changes and Point32Health information systems

+ Comprehensive knowledge of health policy, sufficient to make decisions regarding Plan benefit structures and coverage issues.

+ Influencing others – particularly those outside of direct reporting relationships

+ Ability to define training needs, develop training materials and administer training to small groups.

+ Strong communications skills (formal and informal, written and verbal)

+ Coaching and Mentoring - primarily of direct reports, but also of others

+ Must have commitment to excellence in customer service

+ Considers creative alternatives to traditional/conventional practices and takes risk when appropriate to the situation.

+ Ability to handle multiple demands--must be able to balance multiple priorities

Complexity

+ Expert knowledge of the principles and practices of pharmaceutical science. Working knowledge of managed care and policy development.

+ Requires analytical ability, highly developed oral/written communication skills. Must be self-motivated and capable of working independently with minimal supervision. Must be capable of organizing, facilitating, and managing several projects simultaneously.

+ Requires a high degree of initiative and excellent judgment to make decisions regarding clinical pharmacy issues in an extremely complex and often politically charged environment.

+ Must be flexible and able to constantly review and reset priorities; often daily. Must be able to handle multiple projects simultaneously. Ability to appropriately identify emergency situations and follow through with the appropriate protocol.

Personal Contacts

+ Must be able to work independently as well as cooperatively as a team member. Excellent interpersonal skills, cross-departmental skills required; a high level of diplomacy is necessary to anticipate, analyze and effectively resolve difficult situations and politically sensitive concerns. Frequent communications with Point32Health staff.

+ Capable of communicating with physicians, pharmacists, and other health care specialists as well as a broad range of non-health care professionals. Ability to maintain harmonious working relationships and to communicate effectively both verbally and in writing with health care professional, other departments, network providers, state and federal regulatory and enforcement agencies, pharmaceutical manufacturers, and professional colleagues.

Working Conditions and Additional Requirements** (include special requirements, e.g., lifting, travel) **:

+ Ability and willingness to work irregular hours and to travel in state and out-of-state for job-related purposes, as necessary.

+ Must be able to work under normal office conditions and work from home as required. Occasional evening, weekend, early morning, or extended day work may be required.

+ Must hold a valid driver’s license and have access to and ability to drive an automobile during regular working hours and irregular hours as required.

+ Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.

+ May be required to work additional hours beyond standard work schedule.

The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.

Salary Range

$151,888.80 -$227,833.20

Compensation & Total Rewards Overview

The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity. As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company’s sole discretion, consistent with the law.

Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:

+ Medical, dental and vision coverage

+ Retirement plans

+ Paid time off

+ Employer-paid life and disability insurance with additional buy-up coverage options

+ Tuition program

+ Well-being benefits

+ Full suite of benefits to support career development, individual & family health, and financial health

For more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/

We welcome all

All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

**Scam Alert** : Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact [email protected]

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.