• Manager of Pharmacy Operations

    Job Locations US-RI-Smithfield
    Req No.
    2018-8742
    Department
    Pharmacy
    Type
    Regular Full-Time
  • Overview

    This position works closely with the Director of Pharmacy, Medical Director(s) and Medical Management to oversee and coordinate the daily clinical functional activities within the pharmacy department.   The position develops, implements and maintains daily operational processes in support of pharmacy services to Neighborhood’s members, provider network and pharmacy network.

     

    The position coordinates the clinical pharmacist and technician staff; and the project management for which they are responsible.

    Responsibilities

    • Manages and hires staff that perform the day to day operations of the department.
      • Manages schedules and project time to include pharmacy participation in various rounding activities
    • Responsible for meeting all regulatory requirements pertaining to these operations
    • Collaborates across departments to improve daily department operations pertaining to internal clinical operational processes.
    • Oversees coverage determination, organizational determinations, prior authorization and formulary exception requests for all lines of business (Medicaid, Exchange and Medicare-Medicaid Plans) for all medications whether received through the retail or medical benefit.
      • End-to-end processes from development of criteria, presentation to P&T, submitting requests for coding on appropriate systems and appropriate communication
    • Facilitates Neighborhood Pharmacy & Therapeutics Committee clinical oversight and preparation in collaboration with the Committee Chair and appropriate Pharmacy Department staff.
    • Responsible for identifying new drugs coming to market and recommending strategies for management
    • Collaboration across departments to develop and maintain daily operational processes & programs to support NCQA and HEDIS
    • Oversight of the development and maintenance of pharmacist-led drug utilization review processes.
    • Collaborate within Pharmacy, Member Services and Medical Management departments to ensure internal understanding of pharmacy for member communication.
    • Key contact with and responsible for Delegation Oversight of PBM

    • Responsible for coordination and oversight of required reporting

    • Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood’s Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies, and procedures as it applies to individual job duties, the department, and  the Company. This position must exercise due diligence to prevent, detect, and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents.

    Qualifications

    Required:

    • Pharmacy degree – Bachelor’s degree at a minimum
    • Registered pharmacist with active Rhode Island license in good standing
    • 5 or more years of experience in managed care, in either a health plan or pharmacy benefit management (PBM) setting
    • Experience with managing staff and staff project oversight
    • Knowledge of State and Federal regulations and Accreditation standards
    • Strong verbal, collaboration, and written communication skills
    • Ability to manage multiple tasks and deadlines

    Preferred:

    • Advanced degree such as a doctor of pharmacy or master’s in business administration

    Neighborhood is an Affirmative Action and Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status or any other legally protected basis.

     

    Neighborhood is committed to ensuring individuals with disabilities and/or those who have special needs participate in the workforce and are afforded equal opportunity to apply for jobs. If you would like to contact us regarding the accessibility of our Website or need assistance completing the application process, please contact us at recruiting@nhpri.org

     

    Neighborhood is an EOE M/F/D/V and an E-Verify Employer

    Options

    Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
    Share on your newsfeed

    Need help finding the right job?

    We can recommend jobs specifically for you! Click here to get started.