A wonderful career opportunity forHealth Plan Manager of Pharmacy is now available with a reputable and stable organization in San Francisco Bay Area of California!
The Manager of Pharmacy will be responsible for oversight of administrative and clinical aspects of the health plan’s pharmacy benefit for Commercial, Exchange, and Medicare lines of business and maintenance of regulatory compliance with state and federal authorities. The Manager of Pharmacy will manage daily operations and implements the long-term strategy of the Health Management team with oversight and responsibility in areas of performance improvement (HCCs, Pay for Performance (P4P) and other Alternative Payment Models (APMs)).
The Manager of Pharmacy will manage the relationship with health plan’s pharmacy benefit management (PBM) by serving as the lead on a variety of issues - administrative, compliance and clinical. The Manager of Pharmacy will collaborate with the Medical Director and clinical team and the PBM to develop prior authorization criteria, pharmacy benefit coverage recommendations and formulary alternatives.
The Manager of Pharmacy will coordinate the quarterly Pharmacy and Therapeutics Committee, which includes developing agendas, presenting clinical drug information, monitoring and analyzing prescribing patterns and drug usage. The Manager of Pharmacy conducts
drug utilization review and monitors prior authorization trends to guide recommendations
for additions or changes to the formulary.
The Manager of Pharmacy employs clinical evidence-based methodology and cost-effectiveness considerations for drug coverage decisions. The Manager of Pharmacy oversees the Medication Therapy Management (MTM) program and ensures that proper coordination occurs with all other care management programs. Reports to CMS and all other regulatory/contracted agencies the results of the MTM program, drug-disease interaction programs, medication intervention programs and any other pharmacy clinical initiatives.
The Manager of Pharmacy leads pharmacy-related initiatives that support CMS, STAR, HEDIS measures, URAC quality improvement programs, and other initiatives. The Manager of Pharmacy collaborates with Director of Clinical Services in the integration of pharmacy and health management with medical quality improvement programs. Ensures compliance with state and federal regulations regarding the pharmacy benefit. Serves as primary pharmacy contact with CMS for Part D and DMHC for Commercial and Exchange, which includes phone calls, on-site audits, and additional correspondence.
The Health Plan offers the opportunity for career advancement and diversity. The organization enjoys and promotes a friendly environment with staff experience ranging from new graduates to those who have worked on the unit for over 30 years. Benefits include a self-scheduling model, trained preceptors, and 24/7 leadership on the unit. Join the prestigious team now!