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Vice President Clinical Pharmacy - Great Role with Growing Health Plan!

Company: Fallon Health
Location: Worcester
Posted on: February 14, 2019

Job Description:


* Lead and implement strategies to achieve corporate financial Cost of Care goals for pharmacy cost and utilization through analysis of industry trends, clinical issues, regulatory and compliance requirements, and advise on cost of care opportunities.

* Develop and implement managed care strategies to integrate the pharmacy program into care management and UM programs, to include utilization, risk and case management, grievance and appeals activities.

* Recruit, retain, develop, and motivate staff in Pharmacy Operations and MTM.

* Clearly define and communicate team performance goals for each area of responsibility and assure delivery of those goals.

* Responsible for the budgeting/forecasting process, expense control, capital planning, operation budget of Pharmacy Department.

* Manage PBM relationship in partnership with NDM/Contracting.

* Oversees relationships with the pharmaceutical industry

* Chair of the Pharmacy and Therapeutics CommitteeWorking with Medical Economics, develop reports to meet project and account management needs.

* Analyze data to identify opportunities to influence individual prescriber practices.

* Work directly, either individually or in large group settings, with prescribers to identify and address prescription utilization trends and issues of clinical performance and effect change in prescribing patterns.

* Oversee Medication Therapy Management Program.

* Formulate and implement delivery methodologies for the MTM program that ensure the financial performance of the program.

* Manage the development and the on-going review of the formularies for multiple product lines.

* Oversee Pharmacy Utilization Management processes, compliance, and staffing.

* Support corporate effort to maintain accreditation by agencies including but not limited to CMS, MassHealth, and NCQA.

* Meet with customers, employer groups, benefit representatives, brokers and internal account management staff to explain pharmacy utilization, pharmacy strategy, and programs for improving member satisfaction, quality, and cost management.

* Design and interpret potential impact of benefit design changes for customers.

* Assist in developing responses to Requests for Proposals from potential customers.

* Support Pharmacy-related Fraud Waste, and Abuse efforts.

* Coordinate with NDM/Provider Relations to facilitate and resolve provider pharmacy related issues and concerns.

* Coordinate with Member Services to facilitate and resolve member pharmacy related issues and concerns.


* Doctor of Pharmacy (PharmD)

* Or, BS Pharmacy degree with optional postgraduate training or residency, or with three to five years of experience in managed care delivery, or other clinical or management role with frequent interaction with physicians and other healthcare providers.

* Minimum of four years clinical experience (broad scope preferred).

* A minimum of five years of managed care pharmacy experience, including responsibility for formulary management, prior authorization and other clinical initiatives in a health plan setting required.

* Experience with tenets of quality improvement.

* Excellent presentation and interpersonal skills with effective oral and written communication.Broad experience in managed care with particular emphasis in managed Medicaid and Medicare Part D.

* Experience in managing pharmacy trend through vendor management, formulary management and collaborative relations with providers, either working on the payer side or working with providers in an integrated delivery system/ACO.

* Experience managing both professional staff (other pharmacists) and support staff.

* A comprehensive knowledge of Pharma, PBMs, rebates, and 340B pricing.

* Minimum of ten years clinical experience and at least five in managed care or ambulatory clinical operations leadership.

* JT18

Fallon Health is an equal opportunity employer. It is very important for us to maintain a consistant hiring process for every candidate. In addition, we are also a government contractor with requirements to report on our Affirmative Action planning. To that end, we require everyone to apply online.

If you do not have access to a computer or need assistance completing the application process, please contact Human Resources at 1-508-368-9893 (TRS 711).

Keywords: Fallon Health, Worcester , Vice President Clinical Pharmacy - Great Role with Growing Health Plan!, Executive , Worcester, Massachusetts

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