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Director of Specialty Pharmacy
$150,000.00 - $155,000.00
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Job Title: Specialty Pharmacy Director
Location: Baltimore, MD
The position reports directly to the Senior Director of the Pharmacy Evaluation & Oversight and is a critical leadership position within the unit responsible for understanding the specialty marketplace, opportunities for utilization management, and cost containment. The Director of Specialty Pharmacy will interact frequently with the EVP of Medical Affairs, the CEO, and other senior leaders across the company. The incumbent’s accountabilities include, but are not limited to, the following:
1. Operational Oversight for Effective Specialty Pharmacy Programs
Oversees the operation and evolution, in partnership with our Pharmacy Benefit Manager, to effectively manage members using specialty drugs.
Shapes and directs the guidelines under which the program operates and collaborates with IT professionals within company who aid in delivery and execution.
Understands drugs covered under the program so that all specialty spend can be holistically seen, understood, and evaluated within the care management model for specialty pharmacy members. This model is supported by specially trained nurses at the company who coordinate the care of specialty pharmacy members within the larger programmatic context of the company PCMH/TCCI program.
2. Point of Contact for Specialty Pharmacy Expertise and Oversight
Serves as the key liaison to internal and external stakeholders with regard to specialty pharmacy topics that require business input or clinical judgment about patterns in use, access and impact of specialty pharmacy.
Collaborates and communicates with stakeholders, adjusts business workflows as necessary, and explains program elements to a wide group of internal and external audiences/collaborators.
Integrates and coordinates action between PCMH and Pharmacy.
Provides oversight for Specialty Pharmacy web content.
3. Reporting & Value Realization Analysis Compared to Plan
Responsible for assessing and evaluating program performance against metrics for reporting the value of the Specialty Pharmacy Programs.
Assesses value through clinical outcomes, usage, and financial metrics (among others) generated by the program to assist in meeting strategic plan goals.
Continuously monitors evolving specialty disease medications as they come to market to analyze specialty spend and impact on existing programs.
Reviews industry updates for new specialty care categories that could be included in the Specialty Pharmacy Program.
4. Provider Specialty Medication Reimbursement
Responsible for the project management of the medical prior authorization and claims editing program performed by the PBM vendor
Assists with resolving medical prior authorization related problems
Responsible for the oversight of medical claims pricing within expected turnaround times.
Provides direct supervision of associates responsible for medical drug pricing.
Graduate from an accredited School of Pharmacy, PharmD; MBA is preferred.
Licensure in Pharmacy.
5 years of clinical pharmacy experience in a health plan, hospital, PBM or similar role
Minimum of 2years of experience in a specialty pharmacy related role preferred
Exceptional project management skills and effective at leading in a matrix environment.
Understanding of Specialty Pharmacy and its effect on cost, trend, and patient care.
Experience in specialty pharmaceuticals in both the medical and prescription drug benefit.
Demonstrated success in specialty pharmacy program development, monitoring and quality improvement.
Strong understanding of contemporary clinical, operational, and regulatory pharmacy practices.
Thorough understanding of prescription benefit management programs and practices, contracting, products/services, cost structures, pricing, and business practices.
Experience in formulary management.
Experience in pharmacy education and program development and planning including accreditation of programs.
Experience in clinical technology assessment and implementation.
Experience with and appreciation for working within the highly regulated healthcare industry.
Ability to shape Executive Management’s perspective on key Pharmacy programs by synthesizing key business, technical, and data driven points for successful program definition.
A strong balance between clinical expertise and business acumen that will ensure the most expedient delivery of pharmaceutical management strategies and solutions.
Excellent strategic thinking and planning skills and the ability to develop and implement operational plans.
Ability to identify priorities and achieve results with a sense of urgency and give honest straightforward opinions on related issues.
Proficient at executive level relations and communications both within the company and with business partners, vendors, governmental representatives, and other Health Insurance Industry stakeholders.
Must be able to effectively work in a fast paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Company is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Actual salary will be based on relevant job experience and work history.
The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
The physical demands described here a representative of those that must be met by an associate to perform the essential duties and responsibilities of the position successfully. Requirements may be modified to accommodate individuals with disabilities.
The associated is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The employee must frequently talk and hear. Weights of up to 25 pounds are occasionally lifted.
Must be eligible to work in the U.S. without Sponsorship