Director Pharmacy Benefits
Job ID: 97910 Date posted: September 10, 2019
- Sharp HealthPlan
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Director of Pharmacy Benefits - Sharp Health Plan
The overall purpose Director of Pharmacy Benefits role is to direct and be accountable for all pharmacy benefits administration for Sharp Health Plan bringing value to patients and physicians such that patients receive the highest service in their pharmaceutical benefit while maintaining the highest efficiencies and standards for the mutual success of the health plan, physicians, and patients.
This includes but is not limited to strategic planning for and management of the health plan's various pharmacybenefits and formularies, oversight of delegated entities including the PBM, specialty pharmacy, pharmacynetwork sites, at risk medical groups and others to ensure full compliance with the benefit design, federal and state laws and payer contracts including CMS. This role is responsible for closing gaps in pharmaceutical care for patients and physicians as it relates to each commercial and senior member, integration with hospital pharmacy programs. Acting as the technical and operational expert for all state and federal regulations, guideline and protocol development for pharmaceutical products subject to prior authorization or clinical pathways. Finally to serve as the liaison and pharmaceutical content expert for the health plan in their relationships with employers, brokers, medical providers, state associations, Centers for Medicare and Medicaid Services, pharmaceutical companies, and all other outside constituencies.
Skills and Qualifications:
- Minimum of ten (10) years' experience in managed care.
- Minimum of five (5) years management experience in a health plan or Pharmacy Benefits Management (PBM).
- Minimum 3 years management experience for a Medicare Part D program
- Demonstrated ability to translate organizational priorities into actionable strategies and project future needs
- Experience in complex sales situations with large employers
- Ability to interface with executive level personnel with proven skills in immediate establishment of rapport and credibility in business situations
- Working knowledge of California health care market, risk arrangements, Medicare Part D requirements and RFP processes
- Evidence of ability to manage professional staff and maintain rapport with superiors, peers, subordinates
Education:Pharmacy Doctorate from an accredited college or university.
Licensure: Current unrestricted California Pharmacist strongly preferred.
- Strategic Customer management - Maintain overall accountability for all customers with pharmacy members and directly engage as a leader to manage relationships with the Health Plan's customers with respect to pharmacy benefit management, reporting and performance.
- Build programs to demonstrate the value of Sharp Health Plan's pharmacy program to employers and others.
- Strategy Development - Develop and implement a prescription drug benefit strategy for the health plan to retain existing customers, and drive new business opportunities. Establish quantitative and qualitative metrics required to meet business and customer requirements and achieve health plan financial/growth targets and key goals.
- Model and explore options such as value based benefit designs, use of 340b pricing, limited pharmacy networks and others.
- Oversight and management of Sharp Health Plan's PBM relationship including administrative and financial oversight (under guidance of CFO) and performance audits, adherence to benefit design, guidelines, protocols, CMS Medicare Part D requirements and all state and federal regulations.
- Team development and management - Directly grow and manage a high performing pharmacy team in order to achieve retention, growth and financial goals.
- Senior leader with Sharp Health Plan and Sharp Healthcare to assist in the development and execution of strategies for retention, growth, and improved profitability.
- Leads the development and implementation of health plan pharmacy benefits and formularies with direct and frequent contact with the PBM and medical groups for both patient monitoring and reports to monitor and maximize benefit performance.
- Manages Sharp Health Plans P&T process, formulary development and management.
Compensation and Benefits:
The position provides a very competitive compensation, including opportunity to participate in a management bonus incentive program along with a generous benefit package.
- Position requires the ability to sit for two to three hours at a time.
Must speak and hear clearly.
Close visual perception.
Must be able to use computer terminal keyboard and input data on a continuous basis for two to four hours.
Some use of personal automobile to meet with OON facilities, providers, health plans and attend meetings.
Ability to ambulate frequently over uneven terrain including pavement and stairs.
Additional Physical Requirements may be discussed during the interview
Sharp Health Plan (SHP)
Sharp Health Plan is the largest locally based commercial health plan in San Diego. We are a not-for-profit health plan that has been serving San Diego and southern Riverside Counties since 1992. As a subsidiary of Sharp HealthCare, we are backed by the largest provider of comprehensive health care services in San Diego.
Sharp Health Plan offers a variety of coverage options that combine affordability and choice, while delivering high quality health care and personal service. We provide health insurance for companies of all sizes throughout the region. Members have access to valuable plan enhancements, such as interactive wellness resources, dental discounts and our exclusive global emergency services program.
Sharp Health Plan has received the following accolades:
Highest level “Excellent” Accreditation status from the National Committee for Quality Assurance (NCQA). Sharp Health Plan has received Excellent NCQA status in each of the last three years (2013-2015).
Highest-rated in California among reporting California Health Plans for Rating
of the Health Plan, Rating of Health Care, Rating of Personal Doctor, and Rating
of Health Promotion and Education in the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey.
For the third year running, received 4 out of 4 stars in the Covered California
Quality Rating System.
Considered among the top third of health plans in the nation, receiving an overall
4 out of 5 Pt Rating in NCQA’s Private Health Insurance Plan Ratings for 2015-
Highest rated in Customer Satisfaction in California, having achieved a 4 out of 5
Please note: Unsolicited resumes from employment agencies or other third parties will not be considered.
“Sharp HealthCare is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, disability, gender, gender identity, transgender status, sexual orientation, protected veteran status, among other things, or status as a qualified individual with disability.”
“After nearly 10 years of working here, it's still one of the hardest jobs I've ever loved. If you find a niche here, you'll be working with some of the smartest in the industry. This is where they'll respect you for thinking outside the box and kindness matters. They expect consistency and hard work, but pay you well to do it.”