Apply Now

External Applicant Current Associate

Manager Pharmacy Benefits and Services Job in Irving

Summary:

The Manager Pharmacy Benefits and Services will manage the day to day activities within the department to include: pharmacy staff leadership and oversight, prescription drug benefit design and implementation, regulatory compliance, formulary management, cost effective management prescription drug utilization and costs and member communication/pharmacy experience. The manager will also assist in providing oversight of the pharmacy benefit management services provided by vendors for CHP products/programs.

• Provides oversight and leadership to prescription drug management programs.
• Provides timely support to pharmacy services team and manages the prescription drug authorization and denial process.
• Assists in providing oversight and management of the pharmacy benefit management services, pharmacy programs (including mail order services) and pharmacy network provided by vendors for CHP products/programs.
• Assists with operational oversight and liaison of PBM data/IT transmissions.
• Assists with prescription drug benefit design and implementation.
• Responsible for the coordination and management of all product formulary updates & configuration.
• Oversees and coordinates pharmacy member communication, website content/function and member materials.
• Provides pharmacy management expertise to CHRISTUS Health Plan, collaborates with internal business departments and to standing Committees including :Quality Improvement Committees (USFHP and CHP), Department Oversight Committee (DOC), Medicare Advantage/Health Insurance Exchange Readiness Meetings, and Networks (Health Plan and ACO/CIN) Operation Review meeting.
• Contribute to development of pharmacy programs to improve the health outcomes of health plan members.
• Adhere to code of confidentiality following the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI).
• Advocate accrediting agency standards as needed in carrying out role of Manager Pharmacy Services for the health plan.
• Maintain current knowledge of state and federal regulations, standards, and clinical practice guidelines.
• Communicates, collaborates and coordinates with various providers and Associates as necessary in the performance of duties.
• Oversees and manages prescription drug/pharmacy complaints, grievance and appeals process.
• Provides or arranges for physician review of cases prior authorization and/or appeals as appropriate.
• Assists with clinician drug utilization profiling and feedback.
• Maintain member satisfaction with pharmacy/prescription drug services & programs.
• Assists CMO in planning, establishing goals and policies to improve quality and cost effectiveness of prescription drug care and service of members.
• Monitors and tracks key performance indicators to independently prescription drug cost and utilization trends.
• Manages projects for continuous process improvement of prescription drug and pharmacy services and programs.
• Responsible for ensuring compliance with regulatory (State, CMS, DOD) and accreditation (URAC, NCQA) entities.
• Supports health plan quality work plan initiatives.
• Identifies gaps and recommends go forward strategy to address performance gaps.
• Perform other duties and special projects as assigned.

Requirements:

• Graduate of an accredited College of Pharmacy
• Minimum 2 years of experience as a clinical pharmacist.
• Minimum 2 years managed care and pharmacy management experience
• Knowledge of NCQA, HEDIS, Medicaid, Medicare and Federal programs.
• Knowledge of applicable state, federal and third-party regulations.
• Texas State Board of Pharmacy License

Work Type:

Full Time