Program Manager - Clinical Account Director

Summary

The primary responsibilities of this position are to ensure customer satisfaction, build and maintain trusting relationships with client leadership, retain clients, escalate and resolve operational issues to meet contract expectations and assure operations are aligned with organizational priorities. The position manages the relationships between all stakeholders, develops the pharmacy benefit administration (PBA) business, assures appropriate data evaluation and ensures financial viability. This role partners with the market health plan CEO and other internal business partners.

Your role in our mission

· Serve as primary point of contact for the Missouri Single PBA

· Provide leadership throughout the Missouri PBA including strategic and operational oversight to drive operating model performance and implement strategic initiatives

· Ensures contract objectives and service levels are consistently met

· Partner with leadership team and stakeholders to define top areas for selling, general and administrative expenses and cost of service improvements and implement plans to achieve desired savings

· Oversee business intelligence across business segment to include data, analytics, and reporting requirements for new and existing operations

· Makes recommendations for improvements to meet customer expectations.

· Assures quality improvement initiatives are improving the value and cost effectiveness of PBA operations

· Drives utilization and quality in order to maximize overall program effectiveness

· Leads presentations to client and makes routine client visits

· May have direct reports

· Pharmacy degree and MO licensure highly preferred

· Bachelor’s degree or equivalent combination of education and experience required

· Master’s degree in business or healthcare administration preferred

· 5 or more years of managed care pharmacy or PBM operations leadership experience required at the director level

· Experience with end-to-end pharmacy claims lifecycle, clinical operations, call center management, medication pricing methodologies, NCPDP standards, financial management and managed care statute

· Experience evaluating healthcare data/outcomes is required

· Strong presentation, negotiation, and communication skills required

· Demonstrated leadership ability to drive results across the PBA through team influence and collaboration in a matrixed / shared service organizational model required

What we're looking for

· 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

· Claims Manager

What you should expect in this role

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