Director Specialty Pharmacy Service

The Specialty Pharmacy Services Director oversees the performance of all assigned Children's National specialty pharmacy teams. S/he will be responsible for the overall execution of all programs and ensure that all goals are met with high excellence, urgency, and predictability. S/he will support the growth of the Children's National Specialty Pharmacy program by achieving all service standards, interfacing with executive-level leadership, supporting team building, and staff development. The ideal candidate develops a deep understanding of the challenges health systems face and creatively identifies ways in which the specialty pharmacy can assist in resolving these clinical and financial challenges.

This individual will build, develop, maintain, and measure the performance of all on- and off-site specialty pharmacy programs and oversee staff program performance and training across all sites. S/he will collaborate with clinic leaders and oversee specialty pharmacy prioritization, expansion, and implementation. The Director will assist in planning, developing, and implementing various operational and clinical specialty services, including population health, transitions of care, infusion centers, ambulatory surgery centers, specialty clinics, and future programs.

This role oversees, develops, and monitors the specialty care team and daily departmental operations for specialty pharmacy services and handles complex problem resolution. The Director manages the budget, growth, profitability, and strategic priorities of the specialty pharmacy landscape while delivering operational excellence and efficiency, clinical care, quality, compliance, and accreditation and working in collaboration with other pharmacy Directors.

The Director will provide expert oversight for best-in-class implementation and account management for new specialty product and program launches with pharmaceutical manufacturers, leading initiatives with managed care and payor relations, patient access and financial clearance, risk, and senior leadership that drive development necessary for continued successful execution of manufacturer specialty pharmacy contractual requirements and position Children's National to win additional new specialty pharmacy manufacturer business while managing the specialty drug contracting process to maximize return on investment and minimize business risk.

In coordination with the Vice President of Clinical Ancillary Services, Chief Pharmacy Officer, and other Pharmacy Directors, the Specialty Services Director will work to define the strategic direction of specialty care and medication access services, gene therapies, and offerings to maximize program impact at Children's National.

Minimum Education

Bachelor's Degree BS Pharm (Required) Or

Doctor of Pharmacy (Pharm.D.) PharmD (Required) Or

Master's Degree Concentration in business, marketing, communications, or a related field (Required)

Minimum Work Experience

7 years Experience leading large diverse and remote teams across several [clinical] sites, with a high degree of understanding of the health system space (Preferred)

5 years Previous oversight experience involving pharmacy-related items in outpatient / retail pharmacy setting (Required)

3 years Prior leadership experience. (Required)

Required Skills/Knowledge

Comprehensive knowledge / direct experience in pharmacy, specialty pharmacy, operations, and 340B

Demonstrated excellent oral and written communication skills and the ability to communicate effectively with a broad range of stakeholders including patients and families, clinicians, hospital administrators and public health officials, peers, staff, and leadership

Excellent organizational and time management skills with the ability to meet deadlines, collaborate cooperatively with staff and peers, and manage multi-faceted projects with attention to detail

Ability to remain politically perceptive, work well under pressure, and shift priorities based on contextual requirements

Strong research skills and the ability to perform in a metrics-driven, process-based environment and make data-driven decisions to support justifications for changes and recommendations

Leadership within a specialty pharmacy, health system, or managed care setting with a track record of transformation, team building, and high accountability

Ability to develop and maintain trusted relationships with primary and specialty care providers and pharmaceutical companies and advocate effectively on behalf of patients, families, and underserved communities

Appropriate clinical expertise to triage specialty care referrals and review a medication formulary

Sound financial leadership skills able to develop, forecast, and monitor programmatic budgets

Proven program or project management skills and an ability to organize, develop, implement, monitor, and evaluate professional work goals and performance objectives while working with diverse stakeholders

Demonstrated ability to conceptualize, direct, and implement program and workflow improvement strategies

Strong data analysis, database management, and reporting skills

Self-motivated with the ability to work independently with minimal supervision

Experience working quickly and accurately under time and volume constraints, with clinical knowledge of specialty drugs and treatments

Experience navigating sensitive patient issues such as expanded access requests or financial concerns, as well as the skills to address emerging issues immediately

Advanced understanding of specialty pharmacies, managed care, pharmacy benefit managers, and government payers and their impact on product access

Background in specialty pharmacy accreditation (URAC and ACHC application, process, and maintenance of the accreditation) is a plus

Advanced working knowledge of patient support programs, including reimbursement support, financial assistance, and adherence program

Proficiency with standard software used in a healthcare setting, such as EMR systems (e.g. EPIC, Cerner, Meditech), dispensing systems (e.g. QS/1, RX30, Liberty)

Proficiency in MS Office including Word, Excel, PPT, Outlook

Strong network of industry leaders and analysts preferred

Required Licenses and Certifications

Pharmacist DC 90 Days (Required)

Pharmacist MD 90 Days (Required)

Pharmacist VA (Preferred) Advanced 340B Operations 180 Days (Required)

Certified Specialty Pharmacist (CSP) (Preferred)

Prior Authorization Certified Specialist (PACS) or similar Prior Authorization certification preferred (Preferred)

Functional Accountabilities

Program Development & Implementation:

• Oversee strategic plans and initiatives to establish and grow specialty pharmacy programs, including formation of operational workflows and development of and adherence to program policies and procedures.

• Assess market trends, identify target patient populations, and collaborate with key stakeholders.

• Works with the Pharmacy Procurement team in exceeding manufacturer expectations for specialty medication programs. Design, develop, and track ROI for programs with manufacturers, other specialty pharmacies, clinics, employers, and third-party payers.

• Execute and develop goals, plans, and tactics to ensure specialty pharmacy programs continuously improve in size and profitability.

• Coordinate assistance for any corporate system or process with a component that requires drug therapy expense or revenue analysis (e.g. EHR builds/alert management, clinical management of the prescription drug benefit for employees, development of policies, documents, tools, or education.)

• Drive continuous improvement within operations, leveraging data analysis, technology, industry best practices, and innovation to enhance overall quality and customer satisfaction.

• Collaborate with IT and pharmacy departments to validate new medication build and pricing within the EMR.

• Collaborate with operations, risk, and IT senior leaders to articulate changing market requirements and lead planning for IT and operational specifications necessary for continued successful execution of manufacturer specialty pharmacy contractual requirements and future growth.

• Collaborate with other Pharmacy Directors to review and maintain department policies and procedures for pharmacy services; assist in developing and implementing accrediting agency medication management standards.

• Collaborate with other Pharmacy Directors and Managers to develop and continually maintain a strategic plan for ambulatory pharmacy services that is compatible with the mission of the Division of Pharmacy.

• Facilitate and provide leadership in maintaining and developing clinical pharmacy initiatives, policies, and protocols.

• Share accountability with the pharmacy leadership team for updated and appropriate collaborative practice agreements at all assigned practice areas.

• Identify trends, resolve problems, and develop processes and initiatives to grow specialty pharmacy integration within clinics.

• Assure quality, prompt, and efficient specialty pharmacy services that meet the needs of outpatients and employees.

• Develop and maintain policies and procedures for specialty pharmacy services in order to assure high-quality pharmaceutical care.

• Cost-justify, develop, implement, and assure the quality of new and innovative pharmacy services for specialty pharmacy.

• Maintain ongoing, effective communications with the Pharmacy Services senior leadership and other managers to ensure the timely sharing of program results.

• Serve as a liaison and/or committee member on various specialty pharmacy services committees.

Payor Financial Relations & Patient Access:

• Identify and engage business owners in the planning and implementation of new specialty products.

• Build relationships and work closely with Managed Care to execute contracts for specialty pharmacy medications and services with payers.

• Assist Managed Care with the negotiation of specialty provider SCAs, MOUs, contracts, reimbursement rates, and other collaborative agreements with all participating community and hospital-based specialty practices, and other providers as appropriate.

• Negotiate and manage contracts with specialty pharmacy network providers.

• Manages PBM contract relationships and performs analysis on those contracts.

• Respond to questions surrounding contracts (reimbursement, benefit design, contracted services).

• Assist with follow-up support and documentation requirements.

• Facilitate patient access to pharmaceutical therapy through the prior authorization process.

• Ensure primary care and specialty care providers and patients are trained on referral processes for name-brand medications and are appropriately utilizing the prescription assistance services.

• Assist with determining appropriate routes of billing by utilizing the applicable medical policy and industry standards.

• Monitor industry trends and best practices.

• Ensure the accurate interpretation of benefits and managed care guidelines and guide patients to appropriate programs or resources.

• Monitor and manage specialty pharmacy reimbursement.

• Occasionally assist with the appeals process for denied pharmacy services.

• Keep abreast of environmental, legislative, and regulatory policy changes related to specialty care and medicine access.

• Coordinate with HR and leadership to ensure contracts and partnerships with prescription benefit management companies align with the business needs.

• Establish and continuously monitor patient enrollment, onboarding, and therapy continuation to ensure high patient satisfaction with the patient experience and service levels.

• Coordinate with cross-functional teams to streamline processes and optimize program efficiency.

Financial Management, Performance Metrics & Reporting:

• Collaborate with finance and reimbursement teams to optimize revenue generation, manage reimbursement challenges, and identify cost-saving opportunities.

• Collaborate with other Directors and Managers to develop, analyze, and control annual operating/personnel budgets for specialty pharmacy services. This may require an innovative approach to staffing, inventory control, and service maintenance.

• Recommend action plans to address any significant variance in program expenditures and guard against cost overruns and underruns while ensuring patient resources are available.

• Forecast and prepare specialty pharmacy operating and financial plans.

• Develop and track key performance indicators (KPIs) to evaluate program effectiveness, operational efficiency, and financial performance.

• Generate regular reports to communicate program outcomes, identify areas for improvement, and support data-driven decision-making. Oversee data reporting and analysis.

• Partner with business analysts to ensure adherence to manufacturer requirements, limited distribution drug requirements, and accreditation standards.

Team Leadership, Customer Service, & Personnel Management:

• Hire, train, coach, counsel, and evaluate the performance of direct reports.

• Provide leadership and guidance to a team of specialty pharmacy staff, including pharmacists, technicians, and administrative personnel.

• Foster a positive and collaborative work environment, promote professional development, and resolve any personnel-related issues.

• Provide oversight and ensure compliance with HR policies.

• Review daily reporting and scheduling of hours worked, including sick time, vacation time, and personal and holiday time.

• Ensure exceptional customer service is provided to patients, healthcare providers, and other stakeholders.

• Address inquiries, resolve complaints, and ensure prompt and accurate communication.

• Provide expertise in identifying improvements in pharmacy operations to ensure high levels of service within partner specialty pharmacies.

Quality, Compliance, & Continuous Improvement:

• Develop, implement, and oversee quality improvement programs and clinical committees to ensure the delivery of safe, effective, and high-quality specialty pharmacy services.

• Oversee clinical decision-making aspects of the specialty pharmacy program and provide clinical guidance, monitor medication adherence, track patient outcomes, and conduct program performance evaluations.

• Stay informed about industry advancements, emerging therapies, and best practices to identify program enhancement and innovation opportunities.

• Ensure adherence to applicable laws, regulations, medication contracts, and accreditation standards governing specialty pharmacy operations.

• Oversee compliance with limited distribution drug and specialty pharmacy contract requirements.

• Proactively seek feedback from stakeholders and implement process improvements to optimize patient care and outcomes.

Education, Training & Industry Collaboration:

• Provide education and training to healthcare providers and internal staff regarding specialty pharmacy services.

• Collaborate with the clinical team to develop educational materials and resources.

• Develop, participate in, and oversee research projects that collect, organize, and analyze data. Present research project results and other specialty pharmacy experiences at professional meetings.

• Present research project results and other specialty pharmacy experiences at professional meetings.

• Maintain job expertise within specialty pharmacy by participating in educational forums and professional organizations.

• Foster strong relationships with healthcare providers, payers, pharmaceutical manufacturers, and other stakeholders to ensure effective program collaboration and execution.

• Collaborate and consult with cross-functional partners to achieve operational goals, service levels, and KPIs, resulting in measurable financial results.

• Participate in industry conferences, seminars, and professional organizations to stay informed about current trends, network with peers, and contribute to the advancement of specialty pharmacy practice.

Risk Management & Vendor Management:

• Identify potential risks and develop strategies to mitigate them, such as developing robust medication safety protocols, collaborating with pharmacy managers to navigate drug recalls, and implementing adverse event reporting procedures.

• Collaborate with pharmaceutical manufacturers, distributors, and technology vendors to ensure seamless integration of products and services.

• Evaluate vendor performance, negotiate contracts, and manage relationships to optimize program outcomes and minimize disruptions.

• Coordinate and manage external relationships with pharmaceutical manufacturers, third-party payors, and organizations related to specialty pharmacy.

Organizational Accountabilities

Organizational Accountabilities (Staff)

Organizational Commitment/Identification

Teamwork/Communication

Performance Improvement/Problem-solving

Cost Management/Financial Responsibility

Safety