Principal Pharmacist MedGenerations

Summary

The Principal Pharmacist for MedGenerations provides clinical leadership and oversight to MedImpact’s PDP program. This position requires knowledge of the Part D standard benefit and its linkage to Formulary, Part B versus D benefits, Benefits Design, Finance, Premium Development, and Part D bid components. 

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Provide clinical leadership and oversight of MedImpact’s Medicare Part D Prescription Drug Plan

• Demonstrated ability to undertake the following on behalf of PDP product management:

• Clinical Management - Leads the development and use of clinical strategies and analytics to impact pharmacy trend and improve plan’s Star Ratings including recommendations for formulary development and other clinical programs;

• Utilize pharmacy claims data to identify patterns of utilization and opportunities for financial and clinical plan improvement;

• Monitor and investigate pharmacy claims data to identify patterns of utilization and opportunities for financial and clinical plan improvement;

• Manage Star Ratings Acumen Patient Safety reports including monthly evaluation, ongoing tracking and trending, and other resources;

• Manage all aspects of the clinically related Denied Claim review and Opioid Overutilization Case Management programs including any related updates to proprietary documentation tracking software programs, protocol and P&P development, CMS program compliance and documentation submissions, and staff development and oversight;

• Participates on the MedImpact P&T Committee;

Manage Medication Therapy Management Program (MTMP) criteria, data analysis and trending, MTMP CMS submissions, and perform MTMP vendor oversight;

• Provide support and clinical guidance for plan Compliance Officer, General Manager and Medical Director;

• Clinical spokesperson for the plan during CMS and/or third-party formulary administration audits;

• Directs the development and maintenance of clinical messaging for employers and providers; supports material development for members;

• Plan Sponsor Clinical/Compliance Support - Provides clinical expertise to our CMS plan sponsor, MG Insurance, as required; member of the Compliance Committee.

•  Monitor and investigate pharmacy claims data for suspected FWA and implement strategies for correction;

• Oversees and conducts clinical related monitoring and management of trends originating from appeals and clinical grievances;

• Provides clinical support to brokers/ agents as required in the sales and renewal process;

• Financial Risk Administration - Participates with the underwriting/PDP team in the successful financial development of high-quality affordable pharmacy benefits for the EGWP, market;

• Clinical Trend Management Reporting - Develops reporting packages; monitors reports for PDP costs and performance trends; reports to senior management; implements programs to manage to trend/premium targets;

• Any related duties as required to ensure successful PDP products and financial results.

Supervisory Responsibilities        

Manages assigned staff in the segment area. Responsible for the overall direction, coordination, and evaluation of the unit. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems. Supports and enforces all company policies and procedures in a fair and consistent manner, taking corrective action whenever necessary.

Client Responsibilities

This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written).  One must be able to; manage difficult or emotional client situations; Respond promptly to client needs; Solicit client feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

PharmD Degree; 8+ years related experience and 8+ years of SME in respective area(s); (or equivalent combination of education and experience) with at least 4+ years leading individual contributors and leaders of leaders; which may be substituted with an appropriate mix of leadership experience and 5 years of MedImpact experience plus an appropriate external leadership training program and internal mentorship with a seasoned leader (VP+ level) that must completed within 12 months in new position.

Computer Skills

To perform this job successfully, an individual should have strong knowledge of Microsoft Office Suite and a working knowledge of relational databases.

Certificates, Licenses, Registrations

Registered Pharmacist in the State of California or equivalent state preferred.

Other Skills and Abilities

• CMS audit experience preferred
• In-depth knowledge of the health care industry required.
• In-depth knowledge of the PBM industry and Medicare program strongly preferred.
• Strong understanding of MedImpact a plus.

Reasoning Ability

• Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.

• Ability to define problems, collect data, establish facts, and draw valid conclusions.

Mathematical Skills

• Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. 

• Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume.  Ability to apply concepts of basic algebra and geometry.

Language Skills

• Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community.

• Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.

Competencies To perform the job successfully, an individual should demonstrate the following competencies: