Director, Pharmacy Benefit Management Innovation & Implementation

Job Summary:

The Director, Pharmacy Benefit Management Innovation & Implementation is responsible for cultivating and maintaining the relationship with our Pharmacy Benefit Manager (PBM), including but not limited to issue management and oversight, managing all aspects of Pharmacy implementations, federal and state audit management, pharmacy regulatory and compliance ownership and pharmacy program ownership.

Essential Functions:

• Oversight of Pharmacy Benefit Manager (PBM) strategy and execution, ensuring compliance, goal execution, and contractual requirements are met
• Manage and serve as Pharmacy Compliance business owner to ensure ongoing compliance with all state/federal requirements including audit management, compliance reporting etc.
• Investigate opportunities for pharmacy relationship improvements with existing pharmacies and identifies areas for optimization
• Develop and provide actionable recommendations to senior management relative to the management of our PBM and Third-Party Auditor
• Ensure successful implementation of new and existing business related to the Pharmacy benefit
• Support the budgeting and forecasting processes as related to both vendors
• Manage Subject Matter Expertise on pharmacy claims issues, as needed, to properly guide and develop team members, and explain issues to Senior Management
• Oversight of Pharmacy Benefit Design & Testing
• Manage pharmacy communication strategies and execution with assurance of compliance to state/federal regulations and timelines for go live and approvals
• Manage/oversee business/product readiness associated with documentation, deadlines, filings, cross functional benefit decisions and execution.
• Function as the pharmacy SME in external audits, as necessary
• Performs any other job related duties as requested.

Education and Experience:

• Bachelor's Degree in Healthcare or related field required
• Master's or other advanced degree in related field preferred
• Equivalent years of relevant work experience may be accepted in lieu of required education
• Five (5) years of experience in healthcare or pharmacy required, including experience with management of pharmacy processing, issue and vendor management
• Two (2) years of direct leadership experience required
• Two (2) years of business relationship management experience facilitating the development and implementation of business initiatives and projects required
• Working experience with pharmacy compliance and regulatory requirements required
• Experience communicating and presenting to senior leadership or external regulatory agencies required

Competencies, Knowledge and Skills:

• Advanced proficiency with Microsoft Suite to include Word, Excel, Power Point and Outlook
• Excellent problem solving and root cause analysis skills
• Excellent organizational skills
• Excellent time management skills with ability to manage multiple complex tasks or projects concurrently
• Must excel working in a fast-paced healthcare environment with multiple priorities
• Must be self-directed
• Must be able to effectively manage and prioritize work for a team of individuals
• Ability to effectively report data, analyze facts, and exercise sound business judgement when making recommendations
• Ability to analyze problems, draw conclusions, develop processes and communicate status and results
• Excellent oral and written communication skills
• Ability to interact with executive levels of management as well as external stakeholders
• Auditing skills
• Strong interpersonal, leadership and relationship building skills and high level of professionalism
• Ability to lead and direct the work of others including the development motivation and rewarding of staff

Licensure and Certification:

• None required

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Up to 15% (Occasional) travel based on the needs of the department may be required

Compensation Range:
$132,900.00 - $232,700.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type:
Salary

Competencies:
- Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

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