Description
For over 30 years, AllWays Health Partners has delivered value to our members and worked to improve access to care and coverage. As a member of Mass General Brigham, AllWays is a health plan at the forefront of innovation, advancing a highly integrated model of value-based care with one of the world's leading health care systems. Together, we are transforming the customer experience, keeping our members and patients at the center of everything we do. Bring your unique talents and join us as we strive to create a world where all people live healthier lives.
The Manager of Pharmacy Operations Medicare Advantage will be responsible for day to day clinical operations within the pharmacy department and the management of staff responsible for these activities.
ESSENTIAL FUNCTIONS
STAFF MANAGEMENT & LEADERSHIP
* Day to Day Pharmacy Operations including but not exclusively:
o Manage the activities of the Medicare Advantage Pharmacy team
o Coordination with Care Managers
o Coordination with Customer Care Center on pharmacy issues
o Oversight of implementation of formulary decisions
o Oversight of implementation of New Pharmacy Benefits
o Collaborate with AllWays Health Partners Appeals & Grievance team to ensure regulatory compliance and tracking of metrics related to appeals
o Investigate and respond to grievances related to pharmacy
o Create and maintain policies and procedures related to the pharmacy operations for Medicare Advantage
* Provide clincal oversight of PBM activities and issue management and resolution
* Lead clinical pharmacy management activities of Medicare Part D including but not limited to formulary, utilization management, clinical program development and submission to CMS
* Oversee implementation and communication of changes
* Oversee testing and validation of pharmacy initiatives and reporting
* Ensure CMS requirements are met by leading clinicians and analysts to complete deliverables timely, provide oversight of the PBM and help drive strategiec decisions to improve STAR measures and control pharmacy trend
* Active collaboration with internal and external partners including but not limited to Customer Service, Compliance, Product Management, Clinical UM, Quality, Legal and Regulatory, Sales, Marketing, PBM, other vendors to develop and implement Part D formulary and clinical program offerings
* Lead clinical program oversight of PBM activities related to clinical STAR measures and Medication Therapy Management Program
* Responsible for Drug formulary design and development using an evidence-based process
* Communicate pharmacy benefit information internal to and external to the organization
* Coordinate benefit issues with member services and claims departments
* Interface with network providers on pharmacy related issues
* Responsible for ensuring compliance with all applicable CMS guidance and regulations
* Clinical Pharmacy lead for all audit activities
* Lead pharmacy related clinical initiatives.
* Coordinate pharmacy programs with clinical case and disease management programs.
* P&T Committee support and participation
* Engage, motivate and encourage staff; lead through change and adversity. Make decisions as needed and build consensus as appropriate. Communicate and cascade information to employees in a timely manner and actively participate in the success of cross-organizational programs and initiatives.
* Identify and create the processes and align resources to accomplish key objectives; clearly convey and assign clear accountability for important objectives, deadlines, and expectations.
* Hire, participate in and/or recommend development measures and disciplinary actions up to and including termination, evaluate performance, and supervise the work of all direct and indirect reports following established organizational policies, procedures, and practices.
* Set clear goals and objectives and use metrics to measure performance and hold staff accountable. Provide coaching to improve performance and holds regular development
* Hold self and others accountable to meet commitments.
* Persist in accomplishing objectives, despite obstacles and setbacks to consistently achieve results.
* Build strong customer relationships and deliver solutions that meet customer expectations; establish and maintain effective customer relationships-both internal as well as external.
* Other duties as assigned with or without accommodation.
WORKING CONDITIONS AND PHYSICAL EFFORT
* Work is normally performed in a typical office work environment .
* Work can be performed in a work/remote or hybrid setting
KNOWLEDGE AND EDUCATION
Required:
* PharmD Degree plus 5 years of related experience.
* Valid Unrestricted Massachusetts Pharmacist License Required
EXPERIENCE
Required:
* Minimum of 5 years of experience in managed care pharmacy
* Medicare Part D experience
Preferred/Desired:
* Prior management experience
SKILLS/COMPETENCIES
* Demonstrate AllWays Health Partners' core brand principles of always listening, challenging conventions, and providing value.
* Bring fresh ideas forward by listening to and working with employees and the people we serve.
* Respect the talent and unique contributions of every individual and treat all people in a fair and equitable manner.
* Strong, demonstrated track record of an ability to execute on time, on budget, and on scope.
* Strong aptitude for technology-based solutions.
* Ability to inject energy, when and where it's needed.
* Excellent leadership skills and leadership track record.
* Ability to translate and communicate complex topics in a variety of forums, tailoring communications to effectively fit and influence the targeted audience; strong executive presence, presentation and communication skills. Strong verbal, active listening, and written communication skills required.
* Excellent interpersonal skills, including the ability to influence others at all levels of an organization.
* Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback.
* Unquestionable integrity.
* Excellent organizational and analytical skills.
* Excellent judgment and descion making abilites.
* Strong influencing skills and perseverance
* Ability to develop and motivate employees to meet departmental and organizational objectives.
* Ability to manage multiple projects, meet deadlines and nimbly adjust to changes in company policies, procedures and priorities
* Ability to develop, introduce, defend, and gain support for a new ideas and approachess.
ACTION
Works with minimum supervision, conferring with manager only on unusual matters.
ORGANIZATIONAL RELATIONSHIPS/SCOPE
Reports to the Director of Clinical Pharmacy
