Pharmacy Product Director - Medicare DSNP

Company :

Highmark Inc.

Job Description : 

JOB SUMMARY

This job supports the VP, Pharmacy in managing the overall Pharmacy program administration associated with the respective client portfolio as well as its P&L and contract compliance.  Responsibilities include leading initiatives regarding the specific business line expense trends, cost efficiency strategies, contractual or programmatic changes, quality-of-care outcomes, customer service and other specific product related requirements. The incumbent also contributes to and executes on the strategic plan for his or her product.  The incumbent requires a thorough understanding of all aspects of the pharmacy product. 

ESSENTIAL RESPONSIBILITIES

• Create and maintain strategic partnerships with customers through the development and implementation of product business plans that result in long term retention of profitable relationships.
• Analyze key performance indicator reports, identify negative trend and opportunities for improvement, facilitate internal collaboration to develop and implement solutions, and continuously monitor results to assess the value of implemented initiatives.
• Lead product based pharmacy trend management discussions with internal partners including senior executives.   
• Support contractual pharmacy-based risk-sharing arrangements, and provide industry and product specific Pharmacy insight for capitated rate negotiations and internal financial forecasting.
• Provide clinical expertise, and serve as an influential member of internal clinical and value-based evaluation committees that drive formulary and utilization management functions.
• Participate in product specific Pharmacy and Therapeutics Committees and Drug Utilization Review (DUR) Committees as necessary or contractually required.
• Participate in product specific government meetings as necessary.
• Coordinate implementation of clinical programs and operational requirements as necessary.
• Support product specific business retention and business development activities as necessary.
• Ensure that all contractual obligations including service level agreement (SLA) targets are achieved.
• Ensure that all related regulatory requirements are understood and followed.
• Other duties as assigned or requested. 

QUALIFICATIONS

• Bachelor of Science degree in pharmacy or Doctor of Pharmacy degree
• Active pharmacist license
• 4 years of experience in managed care pharmacy
• 2 years of clinical account management experience in Medicare as part of the 4 year managed care experience
• 2 years of experience analyzing pharmaceutical cost of care data 

Substitutions

• None

Preferred

• Masters of Pharmacy or Masters of Business Administration
• AMCP-ASHP accredited residency in managed care pharmacy
• Experience leading or participating in Pharmacy & Therapeutics committee

Skills 

• Strong analytic capability with experience in executing on insightful quantitative and qualitative data findings
• Mix of clinical expertise combined with business acumen
• Demonstrated competency in identifying opportunities and communicating value-driven solutions
• Ability to think strategically, act urgently, and execute flawlessly
• Ability to establish strong, positive customer relationships
• Ability to lead and encourage others in collaborative problem solving
• Strong interpersonal and written communication skills
• Ability to prioritize multiple projects while successfully meeting all deadlines
• Familiarity with pharmacy benefit management processes or operations

SCOPE OF RESPONSIBILITY  
Does this role supervise/manage other employees?

No

 
WORK ENVIRONMENT
Is Travel Required?

Yes

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 position 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 HRServices@highmarkhealth.org

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