"Alerted.org

Resp & Qualifications

PURPOSE:

The role is responsible for managing day-to-day clinical pharmacy support for the commercial line of business (fully insured risk, ASO), providing guidance to and oversight of clinical pharmacy staff, and directing the contracted Pharmacy Benefit Manager (PBM) plus other vendor(s) under the general direction of the Director, Pharmacy Services. The Manager is responsible for providing clinical expertise related to the commercial pharmacy benefit formularies, utilization management program, clinical programs, implementation of mandates, and implementation of strategies to promote quality and cost-effective medication use. The Manager is expected to assist department leadership with development and implementation of strategies, policies, protocols, and systems that improve productivity, efficiency, and service.

ESSENTIAL FUNCTIONS:

+ Analyze pharmacy and medical utilization data to identify trends and opportunities for cost-effective medication use. Partner with leadership on the development and execution of the overall strategy for all segments of the Commercial Pharmacy business, including cost of care strategies and their performance. Facilitate delivery of pharmacy strategies to prescribers participating in value-based programs. Identify business process improvements that are aligned with and supportive of business goals and objectives, as well as provide thoughtful analyses and recommendations.

+ Support vendor oversight of delegated services to Pharmacy Benefit Manager (PBM), and other clinical pharmacy-focused vendor partners to ensure value realization and high-quality service provision. Ensure vendor(s) are notified of deficiencies in a timely manner and support root cause analysis and resolution of any service deficiencies. Facilitate financial recovery when applicable, and corrective action plans when necessary.

+ Assist in ensuring pharmacy-related processes are carried out in accordance with applicable federal and state requirements, including executive orders, regulatory requirements, advisories, and administrative rules. Support responses to state boards of insurance inquiries and executive inquiries as directed by leadership. Collaborate with the Quality and other departments in supporting quality initiatives and other activities related to HEDIS or NCQA. Oversee the maintenance of the website contents and member/provider/internal communications in accordance with state requirements.

+ Oversee the tasks performed by the Commercial Pharmacy team members. Demonstrates effective performance management of team members and supports activities to maintain a highly functioning team. Make presentations to and develop training, reports, and other communications for internal staff, members, providers, and to other stakeholders related to Commercial Pharmacy. Create, update, and maintain pharmacy program policies and procedures according to NCQA and other governing agencys requirements.

+ Serves as the Commercial clinical pharmacy clinical liaison throughout the organization, remaining current with new and evolving clinical literature to ensure optimal management of pharmacy strategies.

SUPERVISORY RESPONSIBILITY:

This position manages people.

QUALIFICATIONS:

**Education Level:** Pharm.D

Licenses/Certifications Upon Hire Required:

+ PHARMD - Licensed Pharmacist

Experience:

+ 5 years in Managed Healthcare and Pharmacy.

+ 1 year supervisory experience or demonstrated progressive leadership experience.

Preferred Qualifications:

+ Minimum two years of health plan pharmacy experience with a thorough understanding of prescription benefit management programs and practices.

+ Completion of a pharmacy practice or specialty residency (PGY1 or PGY2).

+ Board certification from Board of Pharmacy Specialties (BCPS or BCACP).

Knowledge, Skills and Abilities (KSAs)

+ Strong interpersonal, consultation, organizational, tracking and follow-up skills.

+ Generates high confidence in project output and production.

+ Ability to research, obtain, coordinate, and integrate feedback and directions from diverse operational groups and organizations into a written product.

+ Knowledge of legislative/oversight bodies (e.g., URAC-Utilization Review

+ Accreditation Commission, CMS-Centers for Medicare & Medicaid Services, NCQA-National Committee for Quality Assurance).

+ Requires an in depth understanding of the pharmacy industry including drugs paid for on the medical benefit and pharmacy benefit.

+ Independent worker requiring little oversight, self motivated.

+ Experience and thorough understanding of Microsoft Office products, and other relevant software systems and applications.

+ Data review and interpretation skills required.

+ Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

**Salary Range:** $134,400 - $249,480

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

Pharmacy Management

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

\#LI-LJ1

REQNUMBER: 21650