Found in: Lensa US
Description:
Location: Owings Mills, MD, United States
PURPOSE:
Director, Pharmacy Services is responsible for implementing the organization’s pharmacy vision and strategic plan for government programs including Maryland Medicaid, Dual Prime Special Needs Plan (DSNP), and Medicare Advantage products. This role has oversight of pharmacy staff and develops and maintains collaborative relationships with clinical, administrative, and other key stakeholders including external vendors to ensure effective operations and value realization of pharmacy programs. This role also serves as a key point of contact with the Maryland Department of Health (MDH) and U.S. Centers for Medicare and Medicaid Services (CMS).
ESSENTIAL FUNCTIONS:
Provides oversight and support for the management of multi-faceted Pharmacy Services Government Programs to reduce pharmacy spend, total cost of care, and improve health outcomes. Supports programs from evaluation through implementation and value realization. Monitors and tracks program activity and performance and communicates outcomes to key stakeholders within the organization.
Respond to the Maryland Department of Health (MDH), U.S. Centers for Medicare and Medicaid Services (CMS), and other federal and state agencies as directed by leadership. Assist in ensuring pharmacy related processes are carried out in accordance with MDH, CMS, and other federal and state requirements and guidance, including executive orders, regulatory requirements, and administrative rules. Prepare for annual submissions to and respond to other requests from MDH and CMS. Oversee the creation and maintenance of the website contents, member/provider/internal communications in accordance with NCQA, Medicare, and MDH requirements.
Manages and directs staff, demonstrating effective performance management of team members and supports activities to maintain a high functioning team. Reviews staffing goals and expectations to ensure that each is consistent and adequate to meet department goals. Provides coaching and motivation to team members ensuring staff has appropriate tools and training. Plans and manages the departmental budget.
Serves as a point of contact for CareFirst’s PBM vendor and other strategic pharmacy vendor partnerships. Ensures vendors execute contract terms. Identifies and implements vendor programs based on CareFirst’s needs such as quality initiatives, compliance, population health, and/or member/provider experience.
Analyzes Medicare and Medicaid pharmacy and medical drug utilization data to identify trends and at-risk populations; recommend and develop appropriate interventions; monitors and takes actions on results. Identifies business process improvements that are aligned with and supportive of business goals and objectives. Contributes to the development of dashboards that monitor critical data elements and tracks results for Executive Leaders. Identifies actional insights based on data and helps to ensure successful implementation of clinical savings.
Develops, provides, and oversees formal written and verbal presentations and other communications related to clinical government pharmacy programs. Able to effectively present pharmacy information to key internal and external stakeholders at an Executive Level.
SUPERVISORY RESPONSIBILITY: This position manages people.
QUALIFICATIONS:
Education Level: Medical Degree in Pharmacy
Licenses/Certifications: PHARM D – Licensed Pharmacist Required
Experience:
- 8 years Experience working in the healthcare industry with a focus on a pharmacy benefit administration
- 3 years management experience
Preferred Qualifications:
- Active Pharmacist license in Maryland, or the ability to obtain Maryland licensure within 6 months of employment
- Minimum two years involvement in formulary development, drug use evaluation, and quality improvement activities
- Experience with developing and implementing clinical programs
- Experience with Medicare Part D and Medicaid guidelines and requirements
- Completion of a pharmacy practice or specialty residency (PGY1 or PGY2)
Knowledge, Skills and Abilities (KSAs)
- Entrepreneurial, highly motivated, and collaborative
- Ability to establish credibility and influence persons of all levels and member executive management and lead them to the proper decisions
- Demonstrated track record of building strong relationships, working collaboratively and driving consensus
- Ability to identify diverse needs of member constituencies and develop effective solutions
- Microsoft Office applications (Word, Excel, Access, PowerPoint)
- Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. 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.
Department
Department: Pharmacy Services
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.
Actual salary will be based on relevant job experience and work history.
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
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Serving Maryland, the District of Columbia and portions of Virginia, CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst BlueCross BlueShield Medicare Advantage is the business name of CareFirst Advantage, Inc. CareFirst BlueCross BlueShield Community Health Plan District of Columbia is the business name of Trusted Health Plan (District of Columbia), Inc. In the District of Columbia and Maryland, CareFirst MedPlus is the business name of First Care, Inc. In Virginia, CareFirst MedPlus is the business name of First Care, Inc. of Maryland (Used in VA by: First Care, Inc.). CareFirst of Maryland, Inc., Group Hospitalization and Medical Services, Inc., CareFirst Advantage, Inc., Trusted Health Plan (District of Columbia), Inc., CareFirst BlueChoice, Inc., First Care, Inc., and The Dental Network, Inc. are independent licensees of the Blue Cross and Blue Shield Association. BLUE CROSS®, BLUE SHIELD® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. CareFirst of Maryland, Inc. and The Dental Network, Inc. underwrite products in Maryland only.
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 generic information.
Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States. To comply with this law, CareFirst must collect information regarding an employee’s identity and employment eligibility and document that information on a document referred to as Form I-9, Employment Eligibility Verification, no later than three business days from when the employee begins work for pay. If you are hired, you will be required to provide certain information on the form necessary to establish your identity and eligibility to work in the United States and certain required supporting documents.
If you experience any technical difficulties during this process, please send an email detailing the specific problem you are having to and we will respond as soon as possible.
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c) If you believe that you have experienced discrimination, contact OFCCP at 800-397-6251 (TTY 877-889-5627 ) or .
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