Region Manager Pharmacy Reimbursement-Central

Overview:

CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.

This is a remote position.

Incumbent must be licensed in one of the following states: AZ, IA, MN, ND, NE, or NV

Job Summary

This job is responsible for providing leadership and strategic decision support in the development, implementation and monitoring of strategies, policies and programs to maximize the value of pharmacy resources (product, service, provider) utilization, contracts and vendor performance and optimization of pharmacy revenue.  An incumbent plays a critical role in leading transformative initiatives, acts as a key liaison with leadership, an advisory resource to teams systems-wide and as a representative to external organizations. This position will be a manager and have direct reports. 

Work requires cross-functional facilitation and resourcing of initiatives within a complex value chain while working within a highly distributed team framework and balancing CommonSpirit Health’s business goals and constraints.  Key decisions, supported with appropriate input from key stakeholders, include determining the strategic direction and operational policies for areas of responsibility and others within defined scope. The incumbent will manage the resources of their internal team to accomplish key performance indicators and strategic application of work efforts to support organizational goals. They will also collaborate across regions and work with the system team to accomplish key goals.

An incumbent works collaboratively with diverse teams across the full value chain, including System Pharmacy Operations, Specialty Pharmacy, Patient Care Services, Corporate Services, Business Strategy and Pharmacy Informatics to ensure transparency and coordination to achieve consummate performance and outcomes.

Successful performance requires the ability to effectively apply expertise and working knowledge of the current and future healthcare landscape and critical indicators within the healthcare industry to identify key strategies and opportunities to optimize the ability of CSH to meet the needs of the patient population served.

Key Job Responsibilities

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• Develops, in conjunction with executive leaders and other key stakeholders, strategic initiatives to optimize pharmacy resource utilization, reduce financial risk for patients and CSH, and to optimize pharmacy financial performance and revenue integrity.
• Revenue Cycle:  Serves on the Clinician Advisory Program working closely with teams in Appeals, Audits and Denials as well as Billing/Follow-Up/Prior Authorizations to optimize cash flow, reduce bad debt and write-offs and support patient co-pay assistance programs for high-cost drugs.
• Utilization Review:  Serves as the Pharmacist Advisor liaison to inpatient and outpatient and specialty pharmacy teams to optimize appropriate utilization of high-risk, high-cost drugs, biosimilars and appropriate site-of-service.
• Manages a team of revenue cycle coordinators, billing denials specialists and others as assigned.
• Value Based Care:  Provides consultation and analysis as needed to drive increased value and reduce overall total cost of care with a focus on pharmacy and medication-related programs and alignment with organizational priorities.
• External Partnerships:  Fosters and maintains strong relationships with payers, vendors and other external stakeholders to promote timely identification and resolution of business issues and opportunities to achieve strategic targets.

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Education and Experience

• B.S. or Doctor of Pharmacy degree from an accredited school of pharmacy
• Five recent years of progressively responsible health system management work experience in any pharmacy setting
• ASHP Certificate in Pharmacy Revenue Cycle is preferred
• Active California State Pharmacist License in good standing
• Knowledge of the principles, practices, standards, techniques, requirements and tools/equipment applicable to the pharmaceutical services field, including business development distribution, protocol design, monitoring/intervention and medication management
• Knowledge of the content, intent and application of federal and state regulatory requirements pertaining to matters within designated scope of responsibility
• Knowledge of the principles, practices and methodologies pertaining to healthcare delivery systems
• Knowledge of strategic planning, qualitative/quantitative evaluation and analysis, advanced quality/performance improvement program development/implementation and performance management