Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.
Job Posting Title
Director, Specialty Clinical Solutions- RPH/PharmD required- REMOTE
Job Description Summary
Responsible for support and development of Medical Pharmacy program strategy as part of the Medical Pharmacy Specialty Clinical Solutions team. Responsible for managing current Medical Pharmacy clients and potential new clients. Required to serve as a Medical Pharmacy clinical resource throughout the organization and support all clinical pharmacy programs involving Medical Specialty medications and additional clinical programs as needed. Expected to assume leadership of projects as assigned by VP, Medical Pharmacy Strategy.
Job Description
- Supports overall Medical Pharmacy Product line for health plans through validated program enhancements, creation of usable, client collateral materials with marketing, and onsite client presentations
- Leads evaluation and identification opportunities for improved management of Medical benefit drugs through clinical research and analytics that improve medical cost savings and provide clinical quality initiatives
- Manages current clients in all Medical Pharmacy programs such as Fee Schedule Management, Prior Authorization, Post Service Claim Edits, Site of Service and any additional programs.
- Develops new opportunities and expands programs for existing clients.
- Works with analytics team to provide business rules and develop new drug to market cost impact analyses for health plan clients
- Manages Medical Pharmacy development needs for potential new clients.
- Identifies and develops opportunities for improved process efficiencies for Medical Pharmacy programs.
- Identifies enhanced reporting methodologies for Medical Pharmacy Programs.
- Supports development and production of Medical Pharmacy Trend Report, owning specific sections as delegated
- Supports development, production and monitoring of Specialty Pharmacy Pipeline Report.
- Communicates and collaborates effectively with all internal stakeholders
- Provides Medical Pharmacy expertise within the organization to other business units and within Prime Therapeutics
- Develops potential opportunities and all research and materials for presentations at National pharmacy/healthcare industry meetings, white papers and published papers.
- Develops appropriate submissions for program presentations at National meetings and for publication acceptance.
Responsibilities
7+ years of pharmacy, managed care and pharmaceutical industry experience.
At least 1-2 years' Health Plan Pharmacy experience with knowledge of Medical Pharmacy benefit management strategies.
Strong interpersonal, consultation, organizational, tracking and follow-up skills.
- Pharmacy, Managed Care, Pharmaceutical Industry experience.
- Ability to research, obtain, coordinate, and integrate feedback and directions from diverse operational groups and organizations into a written product.
- Excellent verbal and written communication skills.
- Knowledge of legislative/oversight bodies (e.g., URAC-Utilization Review Accreditation Commission, CMS-Centers for Medicare & Medicaid Services, NCQA-National Committee for Quality Assurance, and ERISA-Employee Retirement Income Security Act of 1974).
- Requires an in depth understanding of the pharmacy industry including drugs paid for on the medical benefit and pharmacy benefit.
- Generates high confidence in project output and production.
- Independent worker requiring little oversight, self motivated.
- Strong communication and presentation skills.
- Experience and thorough understanding of Microsoft Office products, and other relevant software systems and applications.
- Data review and interpretation skills required.
- Must possess RPh or PharmD license in good standing.
- Health Plan experience managing drugs on both Pharmacy and Medical benefit.
Work Experience
Work Experience - Required:
Managed Healthcare, Pharmacy
Work Experience - Preferred:
Education
Education - Required:
Bachelors - Pharmacy
Education - Preferred:
PharmD - Pharmacy
Certifications
Certifications - Required:
RPH - Registered Pharmacist - Pharmacy - Pharmacy
Certifications - Preferred:
PharmD - Doctor Of Pharmacy, State Licensure - Pharmacy - Pharmacy
To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail.
Prime Therapeutics LLC is an Equal Opportunity Employer and a Tobacco-free workplace. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law. Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Positions will be posted for a minimum of five consecutive workdays.
