Pharmacy Manager

Position: Pharmacy Manager

Department: Clinical Services

Supervisor: Pharmacy Director

Job Summary:



The primary responsibility of this position is to manage and provide expertise to support pharmacy operations which include conducting operations meeting with the PBM, supervising department staff, interfacing with CMS for Part D deliverables etc. This involves close coordination and interface with the Plan’s Pharmacy Director, clinical departments, Provider Network, IS, as well as interaction with Med-QUEST. Assures regulatory compliance in all areas relating to pharmacy services operations.


Primary Duties, Responsibilities and Competencies:

Review, update, and propose formulary operational changes quarterly.
Working in concert with the Pharmacy Director to operationalize and implement and maintain care pathways for pharmacy outliers.
Establish, implement, and maintain pharmacy utilization review reports and recommend strategies for operational improvement and monitor Plan objective with targeted strategies with the Pharmacy Director.
Complete MQD’s Annual Pharmacy Reports, and other pharmaceutical reports as requested.
Interface with Company's PBM on operational, and limited IS issues to maximize Plan performance for pharmaceutical services.
Work with appropriate staff to develop, implement, and maintain prior authorization operations and coverage review operations for company's formularies.
Review all benefit plans and ensure changes and updates are operationalized (QUEST-Net, QUEST, & ABD).
Work with the Provider Network Department and Customer Service Department to collaborate with company's network of pharmacies and assist with pharmacy communications, provider and member relations regarding pharmacy operations and services.
Provide advice and support for organizational activities and specific pharmacy projects and initiatives to control pharmacy costs while maintaining effective operations.
Manage pharmacy services and provide staff with direction and supervision.
Assist with the integration and continued operations of Pharmacy Benefits/Services within company's main IS platform.
Establish, implement, and maintain P&P for Pharmacy services.
Manage and assist pharmacy compliance in regards to URAC, HIPAA, and other Federal and State rules and regulations for pharmaceutical services.
Work with PBM to review operational activities related to formulary rebates, AWP pricing, MAC pricing, etc.
Develop, implement and support organizational operations surrounding specialty pharmacy, home infusion and long term care pharmacy services.
Respond to physician and pharmacists inquire when requested for operations by network providers to have peer to peer contact.
Develop, assist and implement pharmacy reports that support case management/reporting activities for compliance with SHCN and the states quality strategy as designated by BBA.
Assist with maintaining clinical formulary edits/rules such as step therapies, quantity edits, prior authorizations and coverage review criteria’s as they relate to operations.
Other duties as assigned.


REQUIREMENTS



Required Competencies and Qualifications:
2 years of experience in retail pharmacy.



Required Education, Licensure or Certification:
Bachelors Degree in related field preferred.


Preferred Competencies and Qualifications:
2 years of management experience preferred.
2 years of managed care experience preferred.
Proficient in word, Excel, and basic Access data bases desired.



Additional Job Requirements:Learn and develop experience in the use of company's information system, QMACS, and company's historical data bases.
Learn and develop experience in the use of Medco Health Solutions Client Website and various reporting tools (Expert) as well as the claims and authorization processing platform/system sponsored by the PBM.
Meets with pharmaceutical representatives from the industry when appropriate.