Description
**Company :**
Highmark Inc.
**Job Description :**
**JOB SUMMARY**
This job oversees the development and implementation of the Organization's prescription drug benefit strategies and products tailored to support their applicable core business segment(s), including the Commercial (self-funded and risk)/Healthcare Reform (ACA) business segments or the Medicare Advantage business segment. The incumbent leads an interdisciplinary team of clinical and non-clinical personnel to develop pharmacy product solutions for the Organization while ensuring compliance with state and/or federal regulations (i.e., Centers for Medicare & Medicaid Services). The incumbent will work collaboratively with other business leaders and teams across the Organization to assess pharmacy product needs and bring offerings to market that align with the overall goals of each business segment with the aim to reduce pharmacy spend, improve member care and generate revenue opportunities to support future growth initiatives, when applicable. Will report up to the Director, Pharmacy Programs, and works with them to maintain successful partnerships with external pharmacy vendors to bring to market streamlined pharmacy solutions in an efficient and compliant fashion. Will interface closely with the Organization's segment support and sales teams to assess client and member needs when identifying and developing pharmacy product solutions and to effectively sell new pharmacy programs to customers. Will work closely with other internal and matrixed Pharmacy teams including Clinical Pharmacy Strategies, Specialty Pharmacy Services, Pharmacy Finance and Operations, Segment Support and Clinical Pharmacy Operations to assess market and operational impact of new programs prior to implementation.
**ESSENTIAL RESPONSIBILITIES**
+ Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plans, organizes, staffs, directs and controls the day-to-day operations of the department; develops and implements policies and programs as necessary; may have budgetary responsibility and authority.
+ Manages the day-to-day operations facilitating the development and implementation of the Organization's prescription drug benefit strategies and products tailored to support their applicable core business segment(s), including the Commercial (self-funded and risk)/Healthcare Reform (ACA) business segments, or the Medicare Advantage business segment.
+ Manage deployment of pharmacy product solutions from pilot to full-scale rollout while ensuring all capabilities deliver administrative effectiveness, support market competitiveness/differentiation, customer satisfaction and financial performance.
+ Ensures pharmacy programs and products are monitored and maintained in accordance with contracts, polices, state and federal regulations, as applicable.
+ Collaborate with key internal and external stakeholders, including other market segment support and product teams and pharmacy vendors (including PBM)
+ Other duties as assigned or requested.
**EDUCATION**
**Required**
+ Bachelor's degree in Business, healthcare or related field
**Substitutions**
+ None
**Preferred**
+ Master's degree in Business, healthcare (i.e. PharmD) or related
**EXPERIENCE**
**Required**
**Preferred**
**LICENSES or CERTIFICATIONS**
**Required**
+ 5 years in a Health Plan or Pharmacy Benefit Manager (PBM)
+ 3 years of leading healthcare program or product development
**Preferred**
+ None
**SKILLS**
+ Analytical and logical reasoning/thinking
+ Problem solving and decision making
+ Oral and written communication skills
+ Management
+ Team buiding
**Language (Other than English):**
None
**Travel Requirement:**
0% - 25%
**PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS**
**Position Type**
Office-based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Occasionally
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
**_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._
**_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._
_As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._
_Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training_
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( _\_files/employers/poster\_screen\_reader\_optimized.pdf\_ )
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Req ID: J196676
