Director of Pharmacy

<p>&nbsp;</p> AgeWell New York is seeking a&nbsp;<strong>Full Time Director of Pharmacy Operations and Part D Services, </strong>experienced in Clinical Pharmacy, Medicare Part D regulations, and health plan operations<strong>, </strong>to join its team of professionals at our offices in Lake Success, NY.

Lake Success, NY, USA

AgeWell New York

<h1>Join the AgeWell New York Team</h1> <p>We offer competitive salaries, excellent benefit packages and the opportunity to work and exchange ideas with leaders in their fields of specialization. We work in a friendly, collaborative environment with exciting career-ladder opportunities.</p>

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Competitive Salary and Benefits

Overview: <p>The Director of Pharmacy Operations is responsible for providing leadership and direction in relation to the managed care plan&rsquo;s clinical pharmacy programs. The Director also develops and implements clinical pharmacy strategies which result in high quality, cost-effective pharmacy management and outcomes, in addition to overseeing the Pharmacy Benefits Management (PBM)/ Part D contract to ensure compliance with state and federal requirements. &nbsp;<br /><br />This position offers competitive compensation, health insurance, dental insurance, life insurance, 401(k) with company match, paid time off, free parking and more. &nbsp;Qualified candidates are encouraged to apply immediately. &nbsp;AgeWell New York is a growing managed care plan, with career development and advancement opportunities.</p>
Responsibilities: <p><strong>Key Tasks Include: </strong></p> <p>Supervise, provide oversight and be the subject matter expert for all pharmacy-related issues internally such as but not limited to:</p> <ul> <li>Oversight and management of Medication Therapy Management and other pharmacy-related Star rating and HEDIS measures</li> <li>Coordinate and submit required CMS reports</li> <li>Utilization review of second level appeal requests for medical necessity</li> <li>Fraud, waste and abuse reporting</li> <li>Opioid overutilization monitoring</li> <li>Manage member access to care and mitigate risks</li> <li>Formulary management, medication utilization and trend reporting</li> <li>As needed, lead projects and collaborative initiatives related to the maintenance and development of AgeWell New York practices related to Part C and Part D regulations.</li> <li>Assist in the development of regulatory and operational business requirements for leading practice implementation of Medicare rules and regulations.</li> <li>Analyze policies, procedures and work processes throughout AgeWell New York related to Medicare Part D in order to identify potential operational improvements that will provide a better customer experience and support improvements in quality rating.</li> <li>Develop education materials, newsletters, member and provider talking points, and disseminate clinical information for both internal and external audiences.</li> </ul> <p>&nbsp;</p> <p><strong>Other Responsibilities:</strong></p> <p>Provide oversight of PBM activities and point be the point of contact for PBM issues such as but not limited to:</p> <ul> <li>Daily pharmacy rejections and adjudication concerns</li> <li>Provide oversight of PBM and other pharmacy vendor contractual agreements</li> <li>Monitoring and oversight of coverage determination, Direct Member Reimbursements, and PBM Call center performance</li> <li>Work with PBM to review CMS guidelines related to Part D operational policies outlined in the Prescription Drug Benefit Manual and HPMS policy memos to ensure proper interpretation and implementation.</li> <li>Review guidance to identify and stratify existing and potential operational issues that impact the Medicare Product. This includes regulatory oversight of Formulary Administration, Drug Utilization Review, Medication Therapy Management, and other areas.</li> <li>Work with the PBM and AgeWell New York departments to implement changes aimed at proactive management of risk areas, and provide the data and reports needed to support improvement initiatives.</li> </ul>
Requirements: <p><strong>Position Requirements: </strong></p> <ul> <li>Bachelor&rsquo;s degree in Pharmacy with five-years of experience in the development and administration of clinical pharmacy programs or Doctoral degree in Pharmacy (Pharm D) with three-years of experience in the development and administration of clinical pharmacy programs in a managed care setting</li> <li>Current license as a Pharmacist in New York State</li> <li>Minimum 8-10 years of work experience as a pharmacist or pharmacy clinical manager, with experience in Medicare health care operations orDif Medicare compliance</li> <li>Thorough knowledge of Medicare Advantage or Medicare Prescription Drug Program operations and regulations</li> <li>Experience related to oversight and understanding of PBM vendors preferred.</li> <li>Ability to work in collaboration with many other functional specialists in developing and implementing work plans with respect to the evaluation and improvement of clinical pharmacy programs and Part D requirements</li> <li>Strong analytical skills, highly organized, ability to handle multiple assignments with overlapping deadlines</li> <li>Excellent written/verbal communication skills</li> </ul>