Resp & Qualifications
PRINCIPAL ACCOUNTABILITIES: The position reports directly to the Senior Director of the Pharmacy Evaluation & Oversight and is a critical leadership position within the unit responsible for understanding the specialty marketplace, opportunities for utilization management, and cost containment. The Director of Specialty Pharmacy will interact frequently with the EVP of Medical Affairs, the CEO, and other senior leaders across CareFirst. The incumbent’s accountabilities include, but are not limited to, the following:
1. Operational Oversight for Effective Specialty Pharmacy Programs
- Oversees the operation and evolution, in partnership with our Pharmacy Benefit Manager, to effectively manage members using specialty drugs.
- Shapes and directs the guidelines under which the program operates and collaborates with IT professionals within CareFirst who aid in delivery and execution.
- Understands drugs covered under the program so that all specialty spend can be holistically seen, understood, and evaluated within the care management model for specialty pharmacy members. This model is supported by specially trained nurses at CVS Caremark who coordinate the care of specialty pharmacy members within the larger programmatic context of the CareFirst PCMH/TCCI program.
2. Point of Contact for Specialty Pharmacy Expertise and Oversight
- Serves as the key liaison to internal and external stakeholders with regard to specialty pharmacy topics that require business input or clinical judgment about patterns in use, access and impact of specialty pharmacy.
- Collaborates and communicates with stakeholders, adjusts business workflows as necessary, and explains program elements to a wide group of internal and external audiences/collaborators.
- Integrates and coordinates action between PCMH and Pharmacy.
- Provides oversight for Specialty Pharmacy web content.
3. Reporting & Value Realization Analysis Compared to Plan
- Responsible for assessing and evaluating program performance against metrics for reporting the value of the Specialty Pharmacy Programs.
- Assesses value through clinical outcomes, usage, and financial metrics (among others) generated by the program to assist in meeting strategic plan goals.
- Continuously monitors evolving specialty disease medications as they come to market to analyze specialty spend and impact on existing programs.
- Reviews industry updates for new specialty care categories that could be included in the Specialty Pharmacy Program.
4. Provider Specialty Medication Reimbursement
- Responsible for the project management of the medical prior authorization and claims editing program performed by the PBM vendor
- Assists with resolving medical prior authorization related problems
- Responsible for the oversight of medical claims pricing within expected turnaround times.
- Provides direct supervision of associates responsible for medical drug pricing.
- Graduate from an accredited School of Pharmacy, PharmD; MBA is preferred.
- Licensure in Pharmacy.
- 5 years of clinical pharmacy experience in a health plan, hospital, PBM or similar role
- Minimum of 2years of experience in a specialty pharmacy related role preferred
- Exceptional project management skills and effective at leading in a matrix environment.
- Understanding of Specialty Pharmacy and its effect on cost, trend, and patient care.
- Experience in specialty pharmaceuticals in both the medical and prescription drug benefit.
- Demonstrated success in specialty pharmacy program development, monitoring and quality improvement.
- Strong understanding of contemporary clinical, operational, and regulatory pharmacy practices.
- Thorough understanding of prescription benefit management programs and practices, contracting, products/services, cost structures, pricing, and business practices.
- Experience in formulary management.
- Experience in pharmacy education and program development and planning including accreditation of programs.
- Experience in clinical technology assessment and implementation.
- Experience with and appreciation for working within the highly regulated healthcare industry.
- Ability to shape Executive Management’s perspective on key Pharmacy programs by synthesizing key business, technical, and data driven points for successful program definition.
- A strong balance between clinical expertise and business acumen that will ensure the most expedient delivery of pharmaceutical management strategies and solutions.
- Excellent strategic thinking and planning skills and the ability to develop and implement operational plans.
- Ability to identify priorities and achieve results with a sense of urgency and give honest straightforward opinions on related issues.
- Proficient at executive level relations and communications both within the company and with business partners, vendors, governmental representatives, and other Health Insurance Industry stakeholders.
- Must be able to effectively work in a fast paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Department: Pharmacy Management
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Please apply before: 8/15/2018
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
The physical demands described here are representative of those that must be met by an employee to perform the essential duties and responsibilities of the position successfully. Requirements may be modified to accommodate individuals with disabilities.
- Must be able to work in an office setting, primarily seated while performing duties for a minimum of 8 hours per work day.
- Walking and standing is required. Lift weight up to 25 pounds on occasion.
- Hands are regularly used to write, type, key and handle or feel small controls and objects. Must be able to type and to speak on the telephone simultaneously.
- Must have the ability to communicate verbally effectively. Auditory ability is to actively listen.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship