Director of Pharmacy Health Plans

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Job Summary

The Director of Pharmacy is responsible for providing clinical responsibility of all pharmacy programs and services including, oversight of formulary development and maintenance, quality assurance programs, Medication Therapy Management program, clinical services provided by PBM, specialty drugs management initiatives, and Maryland Medicaid Value Based Purchasing (VBP) and Medicare Part D stars Program. Other responsibilities include oversight of the P&T Committee, Corrective Managed Care program and collaboration with medical management on data integration, disease management, and outcome projects. Serves as a resource to the CMO for medication use policy activities dedicated to improved clinical and economic outcomes related to drug therapy.

Role Accountabilities Include:

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  Oversees Pharmacy Benefit Manager (PBM) and other strategic pharmacy vendors' compliance with contract terms, including but not limited to benefit setup, clinical programs, and regulatory compliance.

  
  
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  Oversees development and implementation of drug formularies, drug utilization review programs, and Fraud Waste and Abuse (FWA) programs

  
  
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  Provides oversight and support for the management of pharmacy clinical programs.

  
  
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  Leads the pharmacy utilization management program.

  
  
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  Responsible for ensuring compliance with regulatory requirements related to pharmacy benefit management, clinical and quality programs required by the U.S centers for Medicare and Medicaid Services (CMS), State Medicaid Agency, NCQA, and Defense Health Agency (DHA)

  
  
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  Oversees development, management and dissemination of financial, operational, and utilization management reports.

  
  
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  Perform cost/benefit analyses and monitor industry trends/activities to formulate recommendations to Chief Medical Officer on all operational capabilities and future needs to drive decisions for pharmacy benefit service delivery

  
  
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  Manages and directs staff, and maintains a high functioning team.

  
  
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  Oversee audit of claims provided by PBM and network pharmacies, and pharmaceutical purchases under the Prime Vendor program.

  
  
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  Monitors pharmacy cost trend and industry changes, and develop recommendations on effective trend management.

  
  
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  Assist with development of the Medicare Part D bid

  
  

Qualifications

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  Requires a Doctor of Pharmacy (PharmD) degree.

  
  
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  Current Maryland licensure as a registered pharmacist

  
  
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  Five years clinical experience required, with at least two years in a managed care setting.

  
  
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  Two years' experience in formulary and drug utilization management. Two years' supervisory/management experience.

  
  
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  Requires strong knowledge of healthcare/managed care business processes and terminology, including health delivery systems, benefit design, utilization management, medication adherence, quality improvement and all ancillary clinical services.

  
  
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  Requires knowledge of managed care pharmacy including Medicare Part D, Medicaid, and commercial products formulary management, drug utilization management, and quality assurance programs. Requires knowledge of health plan accreditation requirements and HEDIS measures.

  
  

Many organizations talk about transforming the future of healthcare, at Johns Hopkins Health Plans, we are setting the pace for change within the healthcare industry. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for our members and the communities we serve. If you are interested in improving how healthcare is delivered, and have a passion to be at the forefront of change, JHHP is the place to call home.

Please note: US citizenship is required for this position as it falls under the terms of a government contract (to ensure compliance with DODPSP).