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Director Pharmacy Benefits

Job ID 83406 Date posted 10/30/2017
  • Facility: Sharp HealthPlan
  • City: San Diego
  • Department: Health Services
  • Category: Executive Jobs
  • Job Status: Full-Time
  • Shift: Day Job
  • FTE: 1.0
  • Shift Start: Variable
  • Shift End Time: Variable


This position is located in Kearny Mesa, San Diego county


Required Skills and Qualifications

  • Current unrestricted California Pharmacist License
  • Pharmacy Doctorate from an accredited college or university
  • Minimum of ten years’ experience in managed care
  • Minimum of five years’ management experience in a health plan or PBM
  • Minimum three 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  


The overall purpose of this position 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 pharmacy benefits and formularies, oversight of delegated entities including the PBM, specialty pharmacy, pharmacy network sites, at risk medical groups and others to ensure full compliance with the benefit design, federal and state laws and payer contracts including CMS.  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 and 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.
Key Accountabilities/Responsibilities
  • 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
  • Interacts regularly with employers, medical groups and Sharp healthcare entities with respect to both commercial and senior programs, and is the content expert for all pharmacy benefit administration issues.
  • Integrates with Sharp hospital pharmacy programs including but not limited to appropriate formulary development, rapid discharge to pharmacy related programs when appropriate and cost saving measures across the continuum of care.
  • Technical and operational expert to all state and federal regulations and contributes at this level to statewide or national committees in order to better serve the interests of Sharp Health Plan.
  • Creates high level analysis of relevant specialty pharmaceutical utilization and provides guidelines and reports to support the most efficient utilization of pharmacy products.
  • Directs and monitors all education programs to affected populations, representing pharmacy on all multi-disciplinary committees for pharmaceutical care protocols and quality of care initiatives.
  • Develops and implements programs to improve pharmaceutical care, patient safety and med adherence
  • Works directly with quality management to ensure gaps in pharmaceutical care are closed such that Sharp Health plan achieves 75th to 90th percentile ratings in IHA and  4 or more stars in CMS metric measures  
  • Sharp HealthCare is a not-for-profit integrated regional health care delivery system based in San Diego, California. Sharp includes four acute care hospitals, three specialty hospitals and two affiliated medical groups, plus a full spectrum of other facilities and services. Serving a population of approximately 3 million in San Diego County, Sharp has more than 18,000 employees and 3,000 affiliated physicians on medical staffs, and operates 1,850 beds. The Sharp Experience is our unique, system wide commitment to transforming the health care experience in San Diego by becoming the best place to work, practice medicine and receive care.
    Physical Requirements:
    • 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
    Physical Requirements may be discussed during the interview
    “Sharp HealthCare is proud to be an Equal Opportunity/Affirmative Action Employer.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, gender identity, transgender status, sexual orientation, protected veteran status or any other protected class.”
    Keywords: Director of Pharmacy Benefits, Pharmacy Benefits, Health Plan Pharmacy, Formulary, Prescription drug benefit, Executive Pharmacist jobs, Health Plan Pharmacy jobs, Sharp Health Plan jobs, PharmD jobs

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