Position Purpose: Develop, implement and oversee the pharmacy benefit management program across multiple product lines in both centralized and regional environments with multiple locations. Ensure compliance with contractual guidelines of the corporation and health plans impacted by numerous regulatory agencies with complex and often conflicting requirements.
Oversee the pharmacy operations for the business unit, including prior authorization, drug utilization review programs, lock in programs, and plan specific medical management initiatives
Evaluate program performance and recommend to State on program changes that would result in improved costs and higher quality
Formulate and administer related organizational policies and procedures, including pharmacy service quality, pharmacy utilization management and achievement of company goals for pharmacy and medical programs
Responsible for developing and attaining pharmacy AOP initiatives and Per Member Per Month (PMPM) goal
Establish the strategic vision, objectives and policies and procedures for the pharmacy program in support of the corporate strategic vision
Establish necessary infrastructure and processes to ensure achievement of above average Medicare STAR ratings for all pharmacy measures
Oversee the development and implementation of key contracts and ensure that relevant performance standards are met by vendors
Oversee the resolution of disputes, grievances and complaints involving pharmacy program issues
Participate in internal and external accreditation initiatives, relevant boards, task forces, committees, meetings and other activities
Manage relationships with and provide appropriate oversight of key vendors, including pharmacy benefit management and pharmaceutical companies
Support provider education initiatives such as provider profiling, provide participation in cost savings initiatives (appropriate switches to lower cost medications) and incentive programs
Education/Experience: BS in Pharmacy; PharmD preferred. 10 years of clinical pharmacy care and experience.
Thorough knowledge of pharmaceutical care and pharmacy benefit management practices. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff. Quality improvement experience preferred.
License/Certification: Registered Pharmacist with an unrestricted license in the state of employment with eligibility for pharmacy licensure elsewhere. Valid driver's license may be required.
For Pennsylvania Health and Wellness: Registered Pharmacist with an unrestricted license in the state of PA with eligibility for pharmacy licensure elsewhere. Valid driver's license may be required.
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.