What You'll Do:
Lead and support a team of high performing managed care professionals and teams including utilization management, clinical programs, trend management, costs of care programs, quality programs and compliance,
Acquire and maintain top talent within the Corporate Pharmacy Government business vertical and oversee staff, all whom are driven with a common purpose to improve healthcare for all,
Deliver on optimal performance of the Medicare pharmacy program across Medicare Advantage, including DSNP. EGWP and the Medicare Prescription Drug Program (Part D) to include operational expense, medical expense, budgeting and cost of care, and Stars
Oversee Corporate Pharmacy Compliance team and maintain partnerships with corporate compliance stakeholders.
Support the development and execution of strategic plans for the Medicare Segment that will improve affordability, improve quality and strive for optimal PBM service, a favorable partner score card in the area of accountability and performance,
Support growth of BC NC Medicare pharmacy program with innovative, high performing, suite of programs and services to meet the needs across Medicare Advantage, including DSNP, EGWP and the Medicare Prescription Drug Program (Part D)
Develop and maintain strong enterprise government business stakeholder relationships that ensure goal alignment with the Medicare Pharmacy Program,
Develop and maintain strong industry and peer health plan partnerships, to share and gain insights in all areas of Medicare work (operations, quality, cost of care); Foster development of such relationships within the team,
Collaborate with key areas of the organization to ensure expectations of internal and external stake holders of the pharmacy program are met including healthcare, quality, population health, actuarial, finance, data and analytics and sales
Support the development, execution and maintenance of program performance reporting and monitoring
Support the development of CMS Part D bids Medicare Advantage, including DSNP, EGWP and the Medicare Prescription Drug Program (Part D)
What You'll Bring:
Bachelor’s degree in pharmacy or PharmD with 10 years of healthcare management experience.
Expertise in health payer or pharmacy benefits management.
5 or more years of government business experience, including Medicare.
Proven leadership skills dedicated to the development and guidance of staff.
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