Director, Medicare Clinical Operations

Description Medco Health Solutions, Inc. is a leading health care company serving the needs of more than 60 million people.

Medco, the world’s most advanced pharmacy®, provides clinically driven pharmacy services designed to improve the quality of care and lower total health care costs for private and public employers, health plans, labor unions, and government agencies of all sizes, and for individuals served by Medicare Part D Prescription Drug Plans. About one-third of the companies on the Fortune 500 list are Medco clients.

In 2009, Medco captured the No. 1 position in Health Care: Pharmacy and Other Services sector on Fortune’s World’s Most Admired Companies list for the second consecutive year. Of all companies surveyed globally, Medco ranked No. 5 in innovation and No.10 in people management. In the health care sector, Medco ranked No. 1 in seven attributes: innovation, people management, use of corporate assets, quality of management, financial soundness, quality of products/services and global competitiveness. It also ranked No. 2 in the categories of long-term investment and social responsibility.

Come make a difference at Medco-at the head of the industry and at the heart of health. www.medco.com.

Provides oversight and leadership to the clinical specialists and clinical managers within Medicare Clinical Operations. Overall responsibility for the clinical operational activities to support the Medco PDP and Medco’s Medicare client base.
Lead a staff of pharmacists and clinical specialists that have overall accountability and responsibility for:

Medicare Re-installations - responsible for the re-installation of Medicare plans for the existing Medicare Client Base on a yearly basis
oFormulary
oClinical Rules
oOpen Enrollment
oCommunications

Day to Day Medicare Client Support
oHPMS file support - responsible for the production of HPMS files to support Medco’s Medicare Client Base
oMedicare Clinical Rules - responsible for the operationalizing clinical rules and coverage criteria to support Medco’s Medicare Client Base
oCommunications - responsible for the clinical communications necessary to support Medco’s client base
60 day
Retro mailings
guidebooks

Provide the clinical requirements for CMS guidance changes to support the Medco Medicare client base

Provide SME for custom clinical requirements, and coordinate any clinical operational development.

Requirements

Advanced clinical degree preferred (MD, PharmD)in addition to management /administration (MBA or MPA)

Five years experience in a managed care organization is preferred.

1-2 years of Medicare Part D experience preferred

Excellent communication skills, both verbal and written.

Excellent presentation skills.

Good organizational and planning skills.

Excellent interpersonal skills.

Demonstrated leadership ability

We are an Equal Opportunity Employer, M/F/D/V