Under the direction of the Manager, Pharmacy Benefits, pharmacy benefit management programs are developed and implemented. The Pharmacy Benefits Specialist position provides leadership and oversight for pharmacy benefit administration staff and may assume responsibility for the operations of the pharmacy benefit management department in the absence of the Manager. You will assist with the development, management and monitoring of outpatient formularies for Sharp Health Plan to provide the best value to members. You will coordinate pharmacy benefits for members and physicians with direct and frequent contact with Sharp Health Plan’s pharmacy benefits management vendor for formulary changes, member data and reports.
You will interact regularly with Sharp Health Plan’s pharmacy benefits management vendor as well as each contracted medical group, provider, hospital, and becomes the content expert for all pharmacy benefit administration changes. Integrates with 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. You will create high level analysis of relevant specialty pharmaceutical utilization and provides guidelines and reports to support the most efficient utilization of pharmacy products. You will provide direct oversight of the direct prior authorization process for the health plan. Contributes to the oversight of the Sharp Health Plan Pharmacy & Therapeutics Committee. You will provide oversight of responsibilities delegated to PBM vendor, including oversight of compliance with Centers for Medicare and Medicaid Services requirements.
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 is San Diego’s only locally based commercial health plan. With a personal approach and a superior network of medical groups and physicians, Sharp Health Plan advocates for its members by providing unparalleled quality and access to health care services. It operates as a not-for-profit health plan, committed to delivering the best health care for the best value.
As one of the top-rated health plans in California (as measured by the CAHPS satisfaction survey), Sharp Health Plan serves a growing number of companies, large and small, in San Diego and southern Riverside counties.
This position is located in Kearny Mesa, San Diego County
8 hours day shift, 8:00am - 5:00pm, weekends as needed
Required Skills and Qualifications
- Pharmacy Doctorate from an accredited college or university.
- Current unencumbered CA Pharmacist license
- Minimum of three (3) years’ experience in managed care.
- Minimum of two (2) years’ experience in a managerial or leadership role.
- Thorough working knowledge of pharmacy operations, processes and policies appropriate to pharmacy benefit management.
- Strong organizational, analytical and problem solving skills.
- Ability to analyze and interpret data and prepare concise, accurate reports.
- Ability to initiate studies, gather statistical data and trend outcomes.
- Excellent written and verbal communication skills.
- Proficient with Microsoft Office.
Preferred Skills and Qualifications
- Experience with Medicare Part D clinical and regulatory requirements preferred
- Health plan experience preferred
Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.
Keywords: Pharmacy, Pharmacist, Managed Care Pharmacist, pharmacist jobs in San Diego, Medicare Plan D, pharmacist jobs in San Diego, health plan pharmacist