Clinical Operations Manager

Summary

The primary responsibilities of this position are to plan, direct and coordinate the delivery of PBM clinical services, ensuring compliance with healthcare regulations and maintaining a high level of patient care.  Leads the PBM’s efforts to implement pharmacy benefit design best practices that optimize the financial management of ODM pharmacy benefit while improving Medicaid individuals’ health outcomes. The position manages relationships between internal stakeholders, assures appropriate data evaluation and ensures effective utilization management. This role partners with the account manager, operations manager and other internal business partners.

Your role in our mission

• Provides clinical leadership for strategic and operational issues to drive operating model performance and implement strategic initiatives
   
• Ensures clinical contract objectives are consistently met
   
• Accountable for pharmacy and medical claim data mining and analysis in support of developing cost containment strategies
   
• Accountable for analysis and reporting of key pharmacy benefits metrics and success measures
   
• Provides DUR Committee support
   
• Fully dedicated to ODM and is available to be onsite at ODM Columbus Office
   
• Responsible for supporting and serving as back-up for the Account Manager and Clinical Pharmacist, as appropriate
   
• Responsible for overseeing and implementing quality improvement efforts. Assures those efforts improve value and cost effectiveness
   
• Accountable for all PDL and clinical reporting
   
• Accountable for the implementation of PDL
   
• Supports the Ohio Drug Utilization Review Committee, the Ohio Drug Utilization Review Board, and the Pharmacy & Therapeutics Committee
   
• Monitors drug pipeline with special emphasis on high-cost therapies
   
• Makes recommendations for improvements to meet customer expectations
   
• Leads presentations to client and makes routine client visits

What we're looking for

• Pharmacist degree (BS in Pharmacy or PharmD) and licensure required
   
• Master’s degree in Business or Healthcare Administration preferred
   
• 3 or more years of managed care pharmacy or PBM operations leadership experience required at the manager level
   
• Experience with pharmacy claims, clinical operations (including prior authorizations), medication pricing methodologies, NCPDP standards, financial management and managed care statute
   
• Experience evaluating healthcare data/outcomes is required
   
• Strong presentation and communication skills required

• Ability to manage various projects and teams simultaneously
   
• Demonstrated record of improving operational efficiencies and improving financial performance
   
• Excellent verbal and written skills
   
• Understanding of State and Federal regulations; familiarity with the requirements of accrediting organizations
   
• Capable of interacting with medical specialties staff (MDs, Nurses, Care Coordinators, etc), and Pharmacy Leadership
   
• Strong acumen with establishing and monitoring clinical and business performance measures
   
• Strong skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications.  May produce complex documents, perform analysis,
  
  and present to senior leadership and staff