Campus Pride Jobs

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This job directs the development, implementation, oversight and continuous improvement of the systems, processes, policies and staffing necessary to ensure cost effective and consistent pharmacy case management, medication therapy management, member-facing pharmacy quality strategic initiatives, and delivery of targeted member facing pharmacy outreach for a specific segment of the Organization's members and/or specific health management products and services. Ensures attainment of client and/or market-specific operational, clinical, and financial commitments and performance guarantees in addition to improved levels of member and provider satisfaction with the services with the goal of ensuring optimal member outcomes lowering care costs associated with drug therapy. Participates as a key driver of the development and execution of corporate strategies for the effective delivery of proactive, innovative and engaging medication management services. Uses internal analyses and external benchmarking to remain market-competitive and to continuously enhance the services being offered to both group clients and individual members. Specific focus on helping members manage medications across the continuum of care in a high quality, effective and cost-efficient manner while tracking and being responsible for outcomes. Exhibits a passion for patient care and commitment to providing high-quality pharmacy services that optimize health outcomes aligned to Highmark’s Living Health Strategy and product-led operating model.

ESSENTIAL RESPONSIBILITIES

• Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.

• Directs the development, implementation, monitoring and continuous improvement of the systems, processes, policies and staffing to ensure effective medication management services for a specific segment of Highmark’s membership (e.g., national, regional, Medicare Advantage, FEP, special programs, etc.). Includes analysis and determination and reporting of the clinical and financial value of all member outreach.

• Ensures effective processes, including the use of predictive models, for the proactive identification, assessment and engagement of members with targeted and complex drug therapy problems, and high-cost medication regimens

• Collaborates with: 1) Market leaders, and sales to develop and implement solutions for emerging market and client needs including the requirements of CMS; 2) Physician staff in market segment and/or in the clinical function to ensure continuous improvements in the delivery and effectiveness of services and improvement in member outcomes; 3) Product management to develop and deliver competitive pharmacy programs and solutions; 4)the broader health engagement team to ensure a seamless member experience across Highmark’s multidisciplinary clinical teams; 5) other departments to ensure seamless integration of services and optimize patient care.

• Drives operational efficiency through implementation of technology solutions to automate tasks, optimize workflows, and improve data management.

• Uses benchmarking through scientific research, networking, and literature searches to continuously raise the expectations of performance and remain competitive with the product offerings of other health plans, PBMs, and medication management vendors.

• Develops and participates in strategic initiatives based on the business needs. Develops and manages the operational budget.

• Ensure that all staff are delivering services appropriate to meet member’s needs including social barriers and identification and removal of modifiable barrier that interfere with members attaining heath goals. Provide information on appropriate medication use, medication access, adherence, alternative treatment regimens, preventive and chronic care interventions and screening, and close all identified gaps in care related to medication management (quality/STARS metrics). Work to assist members in receiving evidence –based pharmaceutical care

• Oversees development and implementation of policies and procedures that meet the changing business needs while ensuring compliance with all applicable CMS, URAC, NCQA, FEP, DOH and DOI standards and regulations. Complete all required reporting per compliance requirements in professional and timely manner.

• Develop and maintains a comprehensive understanding of relevant regulations and guidelines impacting case management, MTM services, and integrated knowledge of pharmacy UM guidelines

• Other duties as assigned or requested.

EXPERIENCE

Required

• 7 years of experience in clinical pharmacy management in the health plan or pharmacy benefit management (PBM) business segments, with a strong emphasis on medication management and MTM services.

• 5 years of management / supervisory experience or experience leading / working on project teams with proven track record of success in leading and managing pharmacy teams

• 5 years of experience leading a health-related (preferably utilization, medication management) function within a pharmacy related service

• 3 years of experience with diverse populations and delivery models

Preferred

• None

SKILLS

• Strong leadership skills and proven ability to effectively lead and develop department leaders and staff

• Ability to work effectively as a team leader and team member and have a track record of developing and maintain positive relationships with all stakeholders

• Results oriented

• Written and verbal presentation skills, negotiation skills, and skills in positively influencing others with respect and compassion

• Excellent interpersonal and communication skills and the ability to work in a matrix management environment

• Excellent interpersonal / consensus building skills to influence and persuade others as well as the ability to work with a variety of internal and external colleagues from all levels of an organization

• A willingness to embrace and drive change, and adapt to evolving healthcare landscapes, demonstrating a flexible and adaptable leadership style.

• A commitment to serving others and putting the needs of patients, the organization, and its stakeholders first, demonstrating a genuine desire to empower and support others.

• Understanding of healthcare costs and the broader healthcare service delivery system

• Strong analytic skills and problem-solving skills with ability to interpret, evaluate and act on productivity, clinical and financial data.Proficiency in MS Excel and enhanced data and statistical analysis skills.

• Knowledge of relevant regulations and guidelines impacting case management and MTM services

• Demonstrated knowledge in medication management and member engagement strategies

EDUCATION

Required

• Doctorate degree in Pharmacy Or BS in Pharmacy

Substitutions

• None

Preferred

• Master's degree (e.g., MBA, MPH, etc.) highly desirable

LICENSES or CERTIFICATIONS

Required

• Pharmacy License to practice in PA, NY, WV, or DE

• Active pharmacist licensein good standing

Preferred

• Board Certified Medication Therapy Management Specialist (BCMTMS) or a similar credential: Ambulatory Care Pharmacy (BCACP), Geriatric Pharmacy (BCGP), Nutrition Support Pharmacy (BCNSP), Pharmacotherapy (BCPS), Psychiatric Pharmacy (BCPP),

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office- or Remote-based

Teaches / trains others

Occasionally

Travel from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

No

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

$126,400.00

Pay Range Maximum:

$233,700.00

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

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For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Req ID: J253625