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Position:Vice President, Health Plan Pharmacy

Position Summary:Responsible for the development, operations, and results of the Essence Health Plan Pharmacy Program, including guiding clients' Pharmacy Benefits Managers (PBMs), negotiating contracts, ensuring compliance with relevant program requirements, and relevant committees, while impacting clinical support across the organization. Establishes long-range goals, KPIs, and plans. Monitors financial and operational performance and coordinates activities of senior leaders and their respective functions. Serves as a member of the senior leadership team responsible for planning, allocating and monitoring resources, identifying and supporting the organization's mission, strategic plan, and quality improvement initiatives.

Job Description:

Responsible for the development, operations, and results of the Essence Health Plan Pharmacy Program, including guiding clients' Pharmacy Benefits Managers (PBMs), negotiating contracts, ensuring compliance with relevant program requirements, and relevant committees, while impacting clinical support across the organization. Establishes long-range goals, KPIs, and plans. Monitors financial and operational performance and coordinates activities of senior leaders and their respective functions. Serves as a member of the senior leadership team responsible for planning, allocating and monitoring resources, identifying and supporting the organization's mission, strategic plan, and quality improvement initiatives.

Primary Responsibilities:

Provides strategic direction for the department(s). Oversees, coaches, mentors, motivates, supports, and develops a large cross-functional team of seasoned people leaders.  Oversees or supports goal setting/review, regular guidance and 1-1 check ins, career development/planning, upskilling, resource allocation, staffing, budget management, DE&I initiatives, and other People & Culture programs/activities as needed.  Fosters accountability and collaboration to ensure team member and overall team success.Identifies, develops, and oversees team member educational needs, with the goal of optimizing skills and knowledge of emerging approaches to quality/process improvement.Writes, reviews, and seeks approval for policies and procedures, ensuring that both the departmental and organizational needs are met.Develops, implements, and impacts clinical pharmacy strategies which results in high-quality, cost-effective pharmacy management and outcomes. Advises on client CMS Account Management calls as requested.Serves as a subject matter expert for clients' Part D and Part B drug benefit designs as part of the annual CMS bid process.Oversees daily operations for Part B drug prior authorization and Part D appeals request procedures using best practices and quality standards as defined by CMS and NCQA. Ensures compliance with all CMS and NCQA pharmacy related regulations and reporting requirements.Develops and delivers the pharmacy program budget based on the organization's goals.Monitors, evaluates, and presents Plan pharmacy data including reporting of trends for drug utilization, drug costs, and quality metrics (e.g., Part D Star, NCQA). Develops and recommends possible strategies to Lumeris clients to promote cost-effective therapy and quality of care for members.Acts as content creator and Chair of both the Essence Healthcare and Lumeris Pharmacy Oversight Committees. Serves as an advisor, content creator, and contributing participant in clients' Pharmacy Oversight Committees. Negotiates PBM and vendor contracts to maintain market competitiveness and support clients' various benefit design requests. Collaborates with Contracting to support provider contract negotiations, on-site audits, and ongoing monitoring of provider in-office dispensing practices.Ensures the pharmacy program is prepared for audit and review, and survey and accreditation processes by external monitoring agencies, and clients with delegated pharmacy processes. Provides subject matter expertise to meaningfully participate in these audits and surveys.Advises on the preparation of pharmacy data for use in client and provider-specific reports.Oversees all aspects of the PBM contract for multiple clients, including coordination with client PBMs for formulary management. collaborates cross-functionally to gain results.Oversees provider support programs and conducts site visits as necessary. 

Qualifications:

Registered Pharmacist with a Missouri State license15+ years of relevant experience or the knowledge, skills, and abilities to succeed in the role7+ years in management/senior leadership or the knowledge, skills, and abilities to succeed in the roleProven experience in a managed care settingExpert knowledge of state and federal insurance programsExtensive knowledge of pharmacy workflow from prescription to claims submission and authorization request processing, compliance/NCQA standards, and audit processesExpert knowledge of budget creation/management, resource allocation, and contract/vendor managementSuperb leadership skills with the proven ability to coach, develop, and motivate a large team Excellent communication, presentation, and interpersonal skills with the ability to influence at all levels internally and externallyOutstanding project management, analytical, problem-solving, and critical thinking skills with the proven ability to identify, develop, communicate, implement, and impact process improvements and strategic initiativesExceptional judgment, business acumen, and collaboration skillsDistinguished ability to create results in a high-performing and high-growth environment

Preferred:

Doctor of Pharmacy Experience with Medicare Part D

Working Conditions

While performing the duties of this job, the employee works in normal office working conditions.

Disclaimer

The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.

#LI-Remote

Lumeris is an EEO/AA employer M/F/V/D.

The hiring range for this position is:

$203,000.00-$295,250.00

Factors that may be used to determine your actual pay rate include your specific skills, experience, qualifications, location, and comparison to other employees already in this role. This role may also be eligible for incentive compensation. At Lumeris, we are committed to providing a total rewards package that supports your overall well-being. Our benefits include medical, vision, dental, well-being programs, 401(k) with company matching, life insurance, paid time off including paid leave, and so much more. Learn more by visiting our Careers Page.

Member Facing Position: No- Not Member or Patient Facing Position

Location:Remote, USA

Time Type:Full time

Lumeris and its partners are committed to protecting our high-risk members & prospects when conducting business in-person. All personnel who interact with at-risk members or prospects are required to have completed, at a minimum, the initial series of an approved COVID-19 vaccine. If this role has been identified as member-facing, proof of vaccination will be required as a condition of employment.