Medicaid Pharmacy Director

Position Overview

• Location Type: Work at home
• Job Type: Full time
• Salary:

The Clinical Pharmacist Lead (internally known as Pharmacy Director) monitors the drug development pipeline and medical literature, providing clinical support for internal stakeholders. This role utilizes a broad understanding of managed care and PBM knowledge to develop and/or implement strategies and programs to mitigate cost trends and improve health outcomes. The Clinical Pharmacist Lead works on problems of diverse scope and complexity.

This position plans, directs, and monitors all financial, operational, professional, and clinical activities for the development of pharmacy programs for the Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) Illinois Medicare - Medicaid health plan. The individual ensures the pharmacy department provides optimal pharmaceutical services that meet all legal, accreditation, and certification requirements. This position will coordinate day-to-day pharmacy operations directly with the plan Chief Executive Officer and Chief Medical Officer.

Responsibilities

• Keeps current with State and Federal regulations regarding the practice of Pharmacy and implements changes as necessary to maintain compliance, supporting both business and public relations strategies.
• Develops corporate communications to be shared with senior leadership.
• Supports trend management by conducting analysis of drug spend, utilization, and/or approval scenarios.
• Advises executives to develop functional strategies on matters of significance.
• Exercises independent judgment and decision-making on complex issues regarding job duties and related tasks.
• Works under minimal supervision, using independent judgment requiring analysis of variable factors and determining the best course of action.
• Facilitates and consults across teams and manages projects, working collaboratively and communicating with staff in different positions and all levels of management.
• Manages the Humana Illinois FIDE-SNP health plan relationship with Humana Pharmacy Solutions, ensuring compliance with programmatic requirements such as claims processing, prior authorization, formulary management, and clinical programming.
• Represents Humana at all Pharmacy Medicaid meetings, including those with the Illinois Department of Healthcare and Family Services (HFS).

Requirements

• Bachelor’s degree in pharmacy or Doctor of Pharmacy (PharmD).
• Illinois-licensed pharmacist residing or willing to relocate to Illinois.
• Minimum of ten plus years of Pharmacy Experience with at least three years’ experience in managed care and/or PBM operations.
• Successful track record in facilitating and consulting across teams and managing projects.
• Thrives in a fast-paced, multi-project work environment while still ensuring attention to detail.
• Excellent communication skills, both oral and written.
• Proficiency in Microsoft Word, Excel, & PowerPoint.
• Expertise in working collaboratively and communicating with staff in different positions and all levels of management.

Preferred Qualifications

• Master’s degree in public health, Business, or related field.
• Experience with Microsoft Access & Microsoft Project.
• Experience with pharmacy benefits and health benefits.
• Experience with data analytics.

Additional Information

• As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue.