Position Purpose: The Director Pharmacy provides leadership and pharmacist subject matter expertise for the Clinical Pharmacy Operations to achieve division goals and meet Centers for Medicare and Medicaid Services (CMS) requirements; performs related duties as required or assigned.
Directs the clinical pharmacy operations functions to enhance the quality of care and promote cost-effective utilization of pharmaceuticals for members.
Responsible for reviewing, implementing, administering and ensuring compliance with CMS bulletins, memos and guidance as they pertain to benefit management and administration. Attends CMS meetings as appropriate.
Remains current and advises management on industry trends, legislative changes and CMS requirements affecting benefit management and administration.
Coordinates the development and maintenance of the drug formularies. Responsible for overseeing CMS formulary requirements including HPMS file management, required supporting documentation, annual formulary submissions, negative change submissions, print documents, and website.
Oversees and coordinates pharmacy claims processor HPMS submissions of required files.
Communicates and oversees implementation of pharmacy claims processor policy or process changes.
Responsible for content in marketing and member materials including the drug formulary, Provider Directory, Evidence of Coverage, Summary of Benefits and Explanation of Benefits formulary change notification.
Develops, documents and communicates policies and procedures, position papers and process flows pertaining to benefit administration, i.e., annual transition policy and program, tier exceptions, drug coverage status, benefit clarifications and determinations.
Develops annual and ongoing training materials and conducts training programs. Participates in the development of external and internal communications including Pharmacy Network Bulletins, Question and Answer documents and Talking Points.
Responsible for implementing and maintaining quality assurance practices as they relate to written documentation.
Performs as primary pharmacist on all issues that require pharmacists review. Serves as HNPS primary point of contact on benefit issues.
Acts as liaison between HNPS/Health Net and outside entities on Medicare Part D benefit issues.
Represents pharmacy benefit management as a voting member on the Health Net National Pharmacy and Therapeutics Committee. Provides updates as appropriate.
Serves as an HNPS representative on external groups/committees, i.e., AHIP, NCPDP, ICE. Participates in various HNPS and Health Net committees and project teams.
Interviews, hires, trains and develops staff, assigns and monitors work, evaluates performance, rewards and disciplines Associates and participates in proactive succession planning.
Other duties as assigned
Education/Experience: Three years managed care experience required, including a strong understanding of issues and challenges faced by providers, health plans, employers and members. Three years management experience required.
License/Certification: Licensed Pharmacist, with a Pharm.D. degree or comparable clinical experience; Clinical Residency and/or other advanced degree (e.g.
MBA, MHA, MPH, etc.) preferred. Must have and maintain current, valid and unrestricted clinical license.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.