Manager Clinical Pharmacy Operations (Remote)

Highmark; Pennsylvania; Remote; USD 92,000 - 173,000; Full time

Job summary

A leading health insurance company is seeking a Manager of Clinical Pharmacy Operations to oversee pharmacy operations and ensure compliance with healthcare regulations. This role requires strong leadership, excellent analytic skills, and a proven track record in managed care. The successful candidate will drive member engagement and support clinical strategies to enhance drug utilization efficiency while managing a team of pharmacists.

Qualifications

• 3 years of clinical pharmacy management experience.
• 1 year in a leadership role overseeing clinicians.
• Experience with CMS, NCQA, and HEDIS.

Responsibilities

• Manage the clinical pharmacy operations and team.
• Ensure regulatory compliance and guideline adherence.
• Optimize drug utilization and lower care costs.

Skills

Strong analytic skills

Strong leadership skills

Excellent interpersonal skills

Excellent presentation skills

Education

Bachelor's Degree in Pharmacy

Job description

Manager Clinical Pharmacy Operations (Remote)

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Manager Clinical Pharmacy Operations (Remote)

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JOB SUMMARY

This job will be accountable for the clinical pharmacy operations area, specifically the clinical team of pharmacists who support the pharmacy operations team. This job will work closely with the clinical pharmacy strategies and other pharmacy strategy teams to execute on the formulary/utilization (UM) and other strategic pharmacy products. This job will be responsible for managing each of the pharmacists who will drive member engagement with the goal of lowering care costs associated with the Organization's drug utilization across both the pharmacy as well as the medical benefits. This job will have a strong compliance focus to ensure adherence to CMS turnaround times for ACA and MA members and overall handling of medication requests. Additional responsibilities will include adherence to other quality and regulatory requirements including, but not limited to, NCQA, DOH, and additional state-specific mandates.

Company

Highmark Inc.

Job Description

JOB SUMMARY

This job will be accountable for the clinical pharmacy operations area, specifically the clinical team of pharmacists who support the pharmacy operations team. This job will work closely with the clinical pharmacy strategies and other pharmacy strategy teams to execute on the formulary/utilization (UM) and other strategic pharmacy products. This job will be responsible for managing each of the pharmacists who will drive member engagement with the goal of lowering care costs associated with the Organization's drug utilization across both the pharmacy as well as the medical benefits. This job will have a strong compliance focus to ensure adherence to CMS turnaround times for ACA and MA members and overall handling of medication requests. Additional responsibilities will include adherence to other quality and regulatory requirements including, but not limited to, NCQA, DOH, and additional state-specific mandates.

ESSENTIAL RESPONSIBILITIES

• Performs management responsibilities to include, but are not limited to involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.
• Plans, organizes, staffs, directs and controls the day-to-day operations of the department; develops and implements policies and programs as necessary; may have budgetary responsibility and authority.
• Provides direction to a team of clinical pharmacists as members of a multi-stakeholder care team responsible for ensuring appropriate drug utilization across the pharmacy and medical benefit with the goal of lowering drug care costs as it relates to the operations of the Organization's formularies and UM processes such as prior authorizations, exceptions, and other applicable pharmacy edits.
• Ensures adherence to all regulatory and compliance guidelines (CMS, NCQA, DOH, etc.) as it pertains to the pharmacy UM operations functions, turnaround time and overall handling of pharmacy UM/formulary requests.
• Collaborates with the pharmacy organization to ensure that operational impacts of pharmacy UM and formulary policies as well as other pharmacy strategic programs can be accommodated by the operations area.
• Other duties as assigned or requested.
  
  

EDUCATION

Required

• Bachelor's Degree in Pharmacy
  
  

Substitutions

• None
  
  

Preferred

• Pharmacy
  
  

EXPERIENCE

Required

• 3 years of clinical pharmacy management experience including drug use review activities, operational oversight and/or member engagement
• 3 years in managed care pharmacy and/or pharmacy benefit management (PBM)
• 1 year in a leadership role with demonstrated success in building a collaborative team with measurable outcomes related to operational metrics
• 1 year in managing or supervising clinicians (such as pharmacists, nurses, or other clinicians) in a utilization management operations setting in a PBM or Health Plan.
• Experience with regulatory entities such as CMS, NCQA, HEDIS, DOH etc.
  
  

Preferred

• None
  
  

LICENSES or CERTIFICATIONS

Required

• Registered Pharmacist
  
  

Preferred

• None
  
  

SKILLS

• Strong analytic skills with ability to interpret, evaluate and act on productivity, clinical and financial data. Six sigma belt preferred.
• Strong leadership skills with demonstrated success in building effective, collaborative teams
• Ability to work in a high performing team environment that requires flexibility
• Excellent interpersonal and communication skills and the ability to work in a matrix management environment
• Excellent presentation skills both verbal and written and the ability to communicate with all levels of the organization
  
  

Language (Other Than English)

None

Travel Requirement

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting up to 10 pounds

Constantly

Lifting 10 to 25 pounds

Occasionally

Lifting 25 to 50 pounds

Rarely

Disclaimer The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum

$92,300.00

Pay Range Maximum

$172,500.00

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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For accommodation requests, please contact HR Services Online at [e-mail]

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Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Insurance

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