Assistant Vice President - Medical Affairs-Pharmacy Part D - Ochsner Health Plan

We've made a lot of progress since opening the doors in 1942, but one thing has never changed - our commitment to serve, heal, lead, educate, and innovate. We believe that every award earned, every record broken and every patient helped is because of the dedicated employees who fill our hallways.

At Ochsner, whether you work with patients every day or support those who do, you are making a difference and that matters. Come make a difference at Ochsner Health and discover your future today!

This job oversees the pharmacy program operations and alignment with strategic vision of organization. Coordinates and monitors all aspects of the pharmacy and Part D services for our Ochsner Health Plan members. Develops and implements strategic initiatives to support the quality improvement program of the organization by partnering with providers, care management, utilization management, identified stakeholders and others as identified both internal and external to the organization. Supports and collaborates cross-organizationally to drive operational, financial and customer experience elements while assuring overall compliance of the program.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential duties.

This job description is a summary of the primary duties and responsibilities of the job and position. It is not intended to be a comprehensive or all-inclusive listing of duties and responsibilities. Contents are subject to change at the company's discretion.

Education

Required

• Bachelor of Science in Pharmacy

Preferred

• Doctor of Pharmacy (Pharm D)

Work Experience

Required

• 3 years of Medicare Advantage health plan experience which includes CMS Medicare pharmacy requirements, formulary development and compliant bid submissions. 5 years of leadership experience including strategy development and managing team members.

Knowledge Skills and Abilities (KSAs)

• Proficiency in using computers, software, and web-based applications.

• Effective verbal and written communication skills and ability to present information clearly and professionally.

• Strong interpersonal skills.

• Strong organizational skills and ability to set priorities and perform duties calmly and efficiently under pressure.

• Excellent leadership skills and ability to inspire others and manage challenging situations.

• Strong project management skills.

Job Duties

• Oversees contracted Pharmacy Benefits Manager (PBM) including management of invoices, selection and contracting of services as necessary. In conjunction with our PBM, make recommendations to the P&T committee regarding new medications, formulary placement of medications and prior authorization criteria (if applicable).

• Oversees specialty pharmacy vendors or pharmacy services.

• Revises, maintains, and publishes the drug formulary and prior authorization criteria.

• Collaborates with Ochsner Pharmacy and other pharmacies as needed to support members' needs and develop strategies.

• Develops and oversees accurate, actionable reporting to drive strategies related to cost-effective utilization and quality of care.

• Coordinates with product and actuarial support to develop business and pricing strategy, providing thought leadership and the development and submission of compliant Part D bids to CMS.

• Develops and monitors program and departmental metrics.

• Oversees and ensures compliant Part D operations and all applicable reporting requirements and regulations to minimize compliance risk and exposure.

• Writes, reviews, and seeks approval for policies and procedures, ensuring both departmental and organizational needs are met.

• Performs regular analysis of pharmacy data, utilization, quality indicators and cost containment opportunities in collaboration with Chief Medical Officer and Chief Clinical Officer of the plan.

• Actively participate with the Senior Leadership Team, Quality Team, Sales Team and network providers and oversees relationships with corporate support teams and vendors.

• Performs other related duties as assigned.

The above statements describe the general nature and level of work only. They are not an exhaustive list of all required responsibilities, duties, and skills. Other duties may be added, or this description amended at any time.

Remains knowledgeable on current federal, state and local laws, accreditation standards or regulatory agency requirements that apply to the assigned area of responsibility and ensures compliance with all such laws, regulations and standards.

This employer maintains and complies with its Compliance & Privacy Program and Standards of Conduct, including the immediate reporting of any known or suspected unethical or questionable behaviors or conduct; patient/employee safety, patient privacy, and/or other compliance-related concerns. The employer is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability status.

Physical and Environmental Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Sedentary Work

• Exerting up to 10 pounds of force occasionally (Occasionally: activity or condition exists up to 1/3 of the time) and/or a negligible amount of force frequently (Frequently: activity or condition exists from 1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

Normal routine involves no exposure to blood, body fluid or tissue and as part of their employment, incumbents are not called upon to perform or assist in emergency care or first aid.

The incumbent has no occupational risk for exposure to communicable diseases.

Because the incumbent works within a healthcare setting, there may be occupational risk for exposure to hazardous medications or hazardous waste within the environment through receipt, transport, storage, preparation, dispensing, administration, cleaning and/or disposal of contaminated waste. The risk level of exposure may increase depending on the essential job duties of the role.

Are you ready to make a difference? Apply Today!

Ochsner Health does not consider an individual an applicant until they have formally applied to the open position on this careers website.

Individuals who reside in and will work from the following areas are not eligible for remote work position: Colorado, California, Hawaii, Maryland, New York, Washington, and Washington D.C.

Ochsner Health endeavors to make our site accessible to all users. If you would like to contact us regarding the accessibility of our website, or if you need an accommodation to complete the application process, please contact our HR Employee Solution Center at 504-842-4748 (select option 1) or careers@ochsner.org. This contact information is for accommodation requests only and cannot be used to inquire about the status of applications.

We are proud to be an Equal Employment Opportunity and Affirmative Action employer. We are committed to the principles of equal employment opportunity and providing a workplace that is free from discrimination based on race, color, creed, religion, pregnancy status, pregnancy-related conditions, national origin, ancestry, mental or physical disability, medical condition, age, veteran status, military status, citizenship status, marital status, familial status, sexual orientation, gender, gender identity or expression, genetic information, political affiliation, unemployment status, or any other characteristic protected under applicable federal, state or local law. These protections extend to applicants and all employment related decisions. View the EEO is the Law poster and its supplement, as well as the pay transparency policy for more information.

Affirmative Action Policy Statement