Director, MO Pharmacy Benefits Administration Clinical Operations

Summary

The Director, MO Pharmacy Benefits Administration (PBA) Clinical Operations, is a visible client facing role within the Gainwell Pharmacy Center of Excellence. This key role will be responsible for the clinical strategy and oversight of the PBA services operations teams including, but not limited to clinical, operational, claims, and other functions as needed to monitor KPIs, SLAs, productivity metrics, and appropriate staffing levels to ensure that all contractual obligations are met, while guiding process improvement and identifying efficiencies. The individual will be expected to recommend and evaluate the effectiveness of company performance in relation to contracts, delivery and client intent. The ideal candidate will demonstrate leadership qualities, possess a broad knowledge of clinical operations, pharmacy benefit administration services, and a commitment to deliver exceptional client services.

Your role in our mission

· Act as primary point of contact for state Medicaid Pharmacy Director and staff

· Serve as a primary point of contact responsible for the hiring, onboarding, and training of new pharmacy operations staff and ongoing staff development

· Provide wholistic oversight to all account clinical operations contractual activities including clinical activities, prior authorization, and Medicaid drug rebate

· Review and provide feedback to staff and leadership on monthly and quarterly operations reports

· Manage oversight of operations staff productivity and performance, including preparation and delivery of staff performance reviews and evaluations, compliance with audit control objectives

· Provide coaching and feedback to staff on conduct and performance, and support skills development and professional growth that will lead to improved outcomes

· Work with operations and client delivery team leaders to help ensure all monthly and quarterly pharmacy Service Level Agreements (SLAs) are accurate and completed on time

· Ensures pharmacy service policies & procedures, are up to date through the governance process

· Develop subject matter expertise in industry best practices, process improvement and customer service standards of excellence

· Assist and/or lead special projects and ad-hoc client requests as required

· Foster a positive team environment, by upholding corporate culture and values

· Initiates development of clinical operations process improvements, organizational structure, and implementation of technology to increase operational efficiencies and drive quality improvements.

· Proactively lead the performance and direction of clinical pharmacy services including:

o Prior authorization

o Prospective and Retrospective drug reviews

o Management of DUR Board and P&T Committee meetings

o Oversight of clinical services including continuing education and academic detailing

o Development of utilization management criteria

o PDL and formulary management

o Client services and Quarterly Business Reviews

o Quality improvement initiative

What we're looking for

· PharmD (preferred) or Bachelor of Pharmacy degree with Master’s degree in related field

· 10+ years of experience in PBM or MCO Medicaid, 5 years of management experience

· Experience with Medicaid program management (preferred)

· Experience with workforce management tools and productivity tracking

· Experience with P&T Committee, PDL, and DUR Board administration

· Significant experience in the coordination of and collaboration of work teams preferred

Knowledge, Skills, Abilities

· Strong communication, organizational, and problem-solving skills.

· Balances accuracy, quality, and efficiency in all tasks

· A willingness and ability to learn internal systems/processes/programs, as needed

· Strong team orientation with respect for all members

· Advanced computer knowledge including Microsoft Office, use of the internet, and email is required

· Ability to adapt and work collaboratively in a fast-paced, production environment

· Willingness to work a flexible schedule and travel as needed

· Ability to work effectively and efficiently under stringent timelines.

· Ability to analyze and resolve difficult logic and processing issues.

· Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)

What you should expect in this role

 Position is remote. Qualified candidate should reside within, MO; exceptions will be considered. Position requires periodic travel.