Managing Director, Pharmacy Programs

Blue Cross and Blue Shield Association
Washington, DC
Apr 20, 2017
Apr 21, 2017
Executive, Director
Full Time
Overview:Provides the overall strategic leadership, direction, and Management of the Retail, Mail and Specialty Pharmacy vendors, an annual spend of approximately $8.5B. Responsible for identifying and leading the analysis and decision making process concerning formulary management and benefit design for Pharmacy programs and for drugs under the medical benefit, an additional $2B in spend. This position is also responsible for acting as the Co-chair of the Pharmacy and Medical policy committee along with the Chief Medical Officer for the association, overseeing the planning process and the committee operations for approximately 15 external medical experts. Acts as the interface with OPM on all issues concerning drugs under both benefits and coordinates with the Chief Pharmacy Officer for OPM and supports the Executive Director of Integrated Care Management in interactions with the CMO for OPM and the CMO's for Plans within the Blues system.Responsibilities:Responsibilities include but are not limited to:* Leads the ongoing operational and clinical aspects of pharmacy programs ($8.5B annual spend), working with fulfillment PBM's to deliver high quality, efficient care to members of the Federal Employees Program. Oversees the development and implementation of polices and procedures for drugs under both the pharmacy and medical benefits. Identifies innovations in pharmacy practice, develops pilots to test those innovations and then takes successful programs and implement them system wide in FEP to drive health care outcomes that are optimal and are cost effective.* Acts as the co-chair of the Pharmacy and Medical Policy Committee, working with the external vendor who supports the committee as well as the UM groups within ICM to set agendas far in advance, perform the high level administrative functions of the committee and interface with the CMO of the association (the co-chair).* On a periodic basis, leads requests for proposal processes for retail, mail, specialty, PMPC vendor and other procurements to support the pharmacy programs functions. Responsible for overseeing and guiding the RFP development process, the RFP process itself and when needed due to vendor changes, the transition processes.* Responsible for staying abreast of industry trends in pharmacy management and then interpreting and identifying trends that can be leveraged to better manage the delivery of pharmacy services as well as potential new pilot opportunities. This includes the MTM pilots, the specialty drug management pilots and others as they become mature.* Has accountability for leading specialty implementations on both the pharmacy and medical benefits. Leading the analysis and understanding of medical benefit drugs as well as the potential strategic sourcing opportunities in this area, a $2B annual spend.* Acts cross functionally within the ICM department, working with care delivery and pilot programs to increase the functionality of the care management programs.Qualifications:Required Basic Qualifications:* 5 years within a PBM or Health Plan in a senior level position* Clinical management background managing formulary development and implementation* Experienced in presenting drug monographs and evaluations of new drugs to senior executives* History of progressing greater responsibility within a health Plan or PBM* Experience managing pharmacy benefits for a minimum 500K life health Plan* Management experience overseeing a minimum of 10 FTE's* Current licensure as Pharmacist in a minimum of one statePreferred Basic Qualifications:* 10 years within a PBM or Health Plan in a senior level position* Increasing levels of responsibility within either a PBM or a Health Plan with extensive operational experience* Residency in managed care pharmacy* Experience managing pharmacy benefits for a minimum 1M life health Plan* Experience managing a large pharmacy department (20 FTE's) within a health Plan* Experience with Medicare EGWP or Part D Plans and familiar with CMS regulationsEEO Minorities/Gender/Disability/VeteransOptions:Posted by StartWire. Apply now!.

Similar jobs