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Vice President, Medicare Pharmacy Services

Accident Fund Holdings, Inc Southfield Full-Time
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SUMMARY:

Reporting to the EVP of Senior Health Services, the Vice President, Pharmacy Operations is responsible for the strategic direction, growth and full profit and loss for the pharmacy business with over $650M in annual pharmacy spend and is also responsible for oversight over the outsourced Pharmacy Benefits Manager relationship in partnership with the enterprise pharmacy teams. The Vice President will lead a multi-disciplinary team and partner with clinical leadership to drive an integrated pharmacy and medical management model that will continue to reshape the care delivery system and improve the health of patients & customers across the state of Michigan.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:

  • Oversee and direct the development, implementation, and administration of pharmacy programs in alignment with corporate strategies. Develop and maintain cost effective pharmacy program utilizing formulary management to increase medication compliance and ensure appropriate member care and satisfaction. Lead the development of new models of pharmacy and medical integration.
  • Manage all the Prescription Drug Offerings (PDP)
  • Deliver and exceed profitable growth objectives for the Pharmacy Business including the Prescription Drug Offerings (PDP). This includes revenue, expense management, and total net earnings.
  • Provide strategic direction and guidance on all pharmacy initiatives. Lead the development and implementation of annual and multi-year strategic planning processes for the pharmacy operations function.
  • In conjunction with the VP, Commercial Pharmacy Services help oversee the Pharmacy Benefit Manager (PBM) relationship; ensure market competitive PBM and Specialty Pharmacy results while focusing on developing long- term value for customers through clinical pharmacy program innovation. Influence patient and provider desired behaviour's through incentives, formulary, and benefit design.
  • Lead and execute on all Stars Strategies ensuring that the PPO, HMO and PDP exceed 4 Stars
  • Develop a consistent approach to supporting sales and retention of Group PDP customers.
  • Partner with community pharmacists to introduce medication management programs and promote care coordination to increase medication adherence.
  • Anticipate and discuss the impact of large-scale trends, and properly position or reposition the pharmacy business appropriately.
  • Have an understanding of consumer oriented, value driven models with a particular focus on both prevention and chronic care management
  • Lead the assessment of current pharmacy benefits in collaboration with internal departments; provide expertise to internal departments and external stakeholders on benefit design.
  • Develop and assess metrics to evaluate program performance. Identify and implement industry best practices to optimize performance.
  • Serve as the principle spokesperson for the pharmacy program; build productive relationships with internal and external stakeholders to advance corporate strategic priorities.
  • Ensure regulatory compliance; lead and develop programs that solidify company's position as a leader in medication safety and compliance.
  • Integrate the clinical, administrative, and business policies and procedures of the pharmacy department in order to facilitate patient-centered care for members through effective collaboration with internal departments.
  • Oversee the implementation of medication therapy and clinical pathways for primary care providers and physician specialists.
  • Analyse clinical individual and population data, drug program data, and drug therapy data.
  • Develop and ensure adherence to goals and deadlines for departments.
  • Oversee the work of the 80-person pharmacy staff.
  • Provide strategic leadership and direction to management including performance management oversight and employee development.

Performs other related duties which may not be specifically listed in the position description, but which are within the general occupational series and responsibility level typically associated with the employee's class of work.

 

Skills required

Business Development
Management
Business Administration
Team Building
Leadership
Relationship Building
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Job ID: 19-1732

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