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Vice President - Pharmacy Management

Vice President - Pharmacy Management

Job Description

PURPOSE OF THE POSITION:

 

Direct and develop the pharmacy program to support desired Member outcomes through effective clinical management, pharmacy analytics, relationships with Affinity’s Pharmacy Benefit Manager (PBM) partners and internal collaboration with Affinity staff.

 

ESSENTIAL FUNCTIONS

 

  • Effectively manage Affinity’s Pharmacy Benefit Management programs for all Affinity lines of business, including NY Medicaid, FHP, CHP and Medicare. Meet clinical objectives, control costs, monitor pharmacy vendor negotiations, and review, augment, and change pharmacy network size where appropriate. 
  • Establish departmental goals and objectives that are consistent with, and lead to the successful achievement of, divisional and corporate goals and objectives.  Achieve departmental goals and objectives by providing effective leadership, management, strategic direction, and budget and business planning.
  • Ensure that PBM partners meet all contractual obligations and that effective oversight of all third party PBM’s is maintained. 
  • Coordinate efforts between third party PBM’s and all Affinity staff that support Pharmacy Benefits including Pharmacy, Medical Management, Finance, Operations, Customer Service and Regulatory/Legal to facilitate the completion of all required processes and tasks and to ensure that PBM partners are meeting expectations. 
  • Ensure compliance with CMS regulations associated with pharmacy benefits including effective partnership with Affinity’s Medicare Compliance function on reporting requirements and on-going updates. 
  • Ensure operational and reporting compliance with all regulatory requirements including the requirements associated with the NYSDOH Medicaid Carve-In. 
  • Oversee operational aspects and decisions related to formulary and clinical program offerings that are associated with each PBM partner. 
  • Prepare updates to Executive Management regarding overall performance of pharmacy operational, financial and clinical programs. 
  • Develop clinically based analytical programs and utilization reports. Based on data findings, develop pharmacy management program components that support Affinity programs. Operationalize and implement the programs, and develop and monitor outcome measures for each program component focusing on pharmacy, physician and patient elements. 
  • Oversee continuous quality improvement relative to pharmacy initiatives. Regularly monitor and evaluate performance, and realign as needed where appropriate. 
  • Continually assess the effectiveness of departmental functioning, including the people, processes and technologies needed to achieve departmental and corporate goals and objectives.  Identify problems and opportunities for improvement, and generate creative solutions that improve qualitative and quantitative performance. 
  • Ensure staff accountability through routine observation, reporting and performance measurement, and through timely, thorough preparation of performance appraisals for direct staff reports.  Review and approve performance appraisals prepared by department management staff.  Take appropriate action on employee issues related to job performance and professional conduct, with assistance from and in collaboration with the Human Resources department.  
  • Ensure effective, on-going staff training and development activities to achieve objectives of orientation, knowledge and skill enhancement, proficiency/productivity and professional growth for Pharmacy staff. 
  • In collaboration with Human Resources, interview, assess and select new employees for the Affinity Pharmacy team.
  • Stay current with and apply industry best practices, and promote the use of policies and procedures that increase administrative efficiency for Affinity and for pharmacy providers. 
  • Interact with providers, vendors, Members, regulators and other outside organizations/persons in a manner that assures a positive customer experience with Affinity. 
  • Demonstrate proficiency with the principles and methodologies of process improvement.  Apply these in the execution of responsibilities in support of a process focused approach. 
  • Perform other duties as necessary or assigned

Job Requirements

  • BA/BS in Public Health or scientific or quantitative field; Pharm.D degree preferred.
  • Minimum of 8 years of related experience with at least 5 years Pharmacy Benefit Management experience, including experience managing professional staff.
  • Extensive knowledge of business management principles and practices and organizational processes in a health care setting.
  • Comprehensive knowledge of the regulatory environment associated with public health insurance programs.
  • Ability to articulate goals, plan and implement processes to achieve those goals, recognize and assess the implications of confounding variables, anticipate consequences, create contingency plans, and meet deadlines.
  • Process management skills required to identify business and end-to-end process needs, and integrate complex functions and/or highly diverse components of operational units.
  • Ability to use data and qualitative information to create business plans, set goals, measure goal achievement, and identify and solve problems.  Demonstrated knowledge of health care financial management.
  • Advanced interpersonal (e.g., mediating, counseling, mentoring, influencing), negotiating and management skills required to manage critical internal and external relationships and activities that are diverse and complex.  Ability to engage and motivate staff, and collaborate constructively with others within and outside the organization.
  • Excellent oral and writing skills characterized by the ability to communicate thoroughly and clearly to a range of reading and comprehension skill levels.
  • Ability to work resourcefully and creatively, to think independently, and to exercise sound judgment in originating or developing complex techniques or programs in a complex and dynamic environment.
  • Commitment to the corporate mission, vision, and values.
  • High level of integrity as demonstrated by a) appropriate treatment of confidential information, b) adherence to policies, procedures, rules and regulations, c) professional conduct in dealing with persons internal and external to the organization, and d) sensitivity to the populations served by Affinity and the providers with which Affinity works.

Job Snapshot

Employment Type Full-Time
Job Type Health Care
Education Graduate Degree
Experience At least 8 year(s)
Manages Others Not Specified
Industry Insurance
Required Travel Not Specified
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Vice President - Pharmacy Management


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