PBM Policy Manager - Intermountain Health
Murray, UT
About the Job
Job Description:
The Pharmacy Services Manager provides leadership and direction to SelectHealth Pharmacy Services and SelectHealth Prescriptions. This position contributes to the strategic and clinical direction of the department. The Manager identifies and promotes the changes needed to provide cost-effective quality pharmacy benefits to members.
Schedule
Regular business hours 8-5. Position can be remote with some time required in office.
Remote with some office time and travel required
Join Scripius, a rapidly growing and innovative PBM subsidiary of Select Health Scripius is a full service transparent PBM that is disrupting the traditional PBM model and is experiencing rapid growth. Scripius provides pharmacy benefit management services to over 1.7 million members. At Scripius, we value innovation, transparency, and clinical excellence. Scripius offers numerous professional development and growth opportunities. We invite passionate innovators to join us on this exciting journey!
Scope
Provides direct management to pharmacy clinical coordinators multiple pharmacy residents and the business development consultant.
Job Essentials
Analyzes pharmacy claims to identify areas of utilization aberrations and opportunities for cost-efficiencies.
Manages the clinical administration of Pharmacy Services including formulary, academic detailing/education, and the residency program. Oversees the Pharmacy & Therapeutics (P&T) Newsletter and other communications to providers and pharmacies.
Ensures coordination and communication of pharmacy benefit management (PBM) programs including drug manufacturer contracting, P&T Committee activities, physician communication/education, retail/community pharmacy, NCQA qualification, information services, clinical intervention programs, drug usage evaluation programs, and pharmacy outcomes research.
Ensures coordination and communication of PBM programs with standalone PBM clients and geographic expansion partners.
Maintains positive partnerships and relations with contracted retail pharmacies and pharmaceutical companies.
Coordinates, manages, and monitors pharmacy claims processing services, utilization management, and prior authorization protocols.
Participates in, and works with, corporate drug manufacturers to obtain rebates, price discounts and disease management plans, or other cost reductions.
Aids in contracting and auditing the SelectHealth Pharmacy Network.
Coordinates clinical pharmacy programs with the different Intermountain Clinical Programs.
Conducts Drug Utilization Review projects as appropriate, which includes ability to query and analyze pharmacy data.
Coordinates and oversees Pharmacy Resident Program and student rotations.
Coordinates the appropriate use of specialty medications, including contractual arrangements and claims adjudication.
Promotes stand alone PBM through relationships with brokers and key employer group executives.
Supports the education and promotion of pharmacy services to both internal and external customers.
Responsible for the administration of all medication therapy management programs for Medicare Part D, Medicaid, Commercial lines of business and medical homes.
Provides direct support and direction for the management of Medicaid pharmacy services and the Medicaid Restriction program in order to assure maximal cost-effective benefit administration.
Responsible for the creation and maintenance of the SelectHealth medication fee schedules that include: the MAC list for pricing of generic drugs, J-code fee schedules for use in physician offices, retail pharmacies, specialty pharmacies, home health and infusion centers.
Minimum Qualifications
Pharm D. degree or Masters degree from an accredited school of pharmacy. Degree will be verified.
State license to practice pharmacy and dispense controlled substances.
Five years of pharmacy practice experience in a managed care and hospital environment.
- and -
Five years of Pharmacy Benefits management experience.
Preferred Qualifications
Advanced degree in business management or healthcare administration.
+ Pharmacy experience in a managed care setting including an ASHP accredited managed care residency.
+ Strong health care systems orientation including: managed care, retail and hospital pharmacy, pharmacy contracting, pharmaceutical company contracting
+ Strong verbal and written communication skills.
+ Personal computer skills including word processing and spreadsheets.
+ Working knowledge of the laws and regulations in Idaho, Nevada and Colorado preferred. Experience working with regulators and policy makers at both the state and federal levels. Ability to analyze proposed regulations and legislation and understand potential impacts to our business and the market.
Physical Requirements:
SH only
Interact with others requiring employee to verbally communicate as well as hear and understand spoken information.
- and -
Operate computers, telephones, office equipment, and manipulate paper requiring the ability to move fingers and hands.
- and -
See and read computer monitors and documents.
- and -
Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.
Location:
SelectHealth - Murray
Work City:
Murray
Work State:
Utah
Scheduled Weekly Hours:
40
The hourly range for this position is listed below. Actual hourly rate dependent upon experience.
$76.97 - $110.90
We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.
Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers (https://intermountainhealthcare.org/careers/working-for-intermountain/employee-benefits/) , and for our Colorado, Montana, and Kansas based caregivers (http://www.sclhealthbenefits.org) ; and our commitment to diversity, equity, and inclusion (https://intermountainhealthcare.org/careers/working-for-intermountain/diversity/) .
Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
All positions subject to close without notice.
The Pharmacy Services Manager provides leadership and direction to SelectHealth Pharmacy Services and SelectHealth Prescriptions. This position contributes to the strategic and clinical direction of the department. The Manager identifies and promotes the changes needed to provide cost-effective quality pharmacy benefits to members.
Schedule
Regular business hours 8-5. Position can be remote with some time required in office.
Remote with some office time and travel required
Join Scripius, a rapidly growing and innovative PBM subsidiary of Select Health Scripius is a full service transparent PBM that is disrupting the traditional PBM model and is experiencing rapid growth. Scripius provides pharmacy benefit management services to over 1.7 million members. At Scripius, we value innovation, transparency, and clinical excellence. Scripius offers numerous professional development and growth opportunities. We invite passionate innovators to join us on this exciting journey!
Scope
Provides direct management to pharmacy clinical coordinators multiple pharmacy residents and the business development consultant.
Job Essentials
Analyzes pharmacy claims to identify areas of utilization aberrations and opportunities for cost-efficiencies.
Manages the clinical administration of Pharmacy Services including formulary, academic detailing/education, and the residency program. Oversees the Pharmacy & Therapeutics (P&T) Newsletter and other communications to providers and pharmacies.
Ensures coordination and communication of pharmacy benefit management (PBM) programs including drug manufacturer contracting, P&T Committee activities, physician communication/education, retail/community pharmacy, NCQA qualification, information services, clinical intervention programs, drug usage evaluation programs, and pharmacy outcomes research.
Ensures coordination and communication of PBM programs with standalone PBM clients and geographic expansion partners.
Maintains positive partnerships and relations with contracted retail pharmacies and pharmaceutical companies.
Coordinates, manages, and monitors pharmacy claims processing services, utilization management, and prior authorization protocols.
Participates in, and works with, corporate drug manufacturers to obtain rebates, price discounts and disease management plans, or other cost reductions.
Aids in contracting and auditing the SelectHealth Pharmacy Network.
Coordinates clinical pharmacy programs with the different Intermountain Clinical Programs.
Conducts Drug Utilization Review projects as appropriate, which includes ability to query and analyze pharmacy data.
Coordinates and oversees Pharmacy Resident Program and student rotations.
Coordinates the appropriate use of specialty medications, including contractual arrangements and claims adjudication.
Promotes stand alone PBM through relationships with brokers and key employer group executives.
Supports the education and promotion of pharmacy services to both internal and external customers.
Responsible for the administration of all medication therapy management programs for Medicare Part D, Medicaid, Commercial lines of business and medical homes.
Provides direct support and direction for the management of Medicaid pharmacy services and the Medicaid Restriction program in order to assure maximal cost-effective benefit administration.
Responsible for the creation and maintenance of the SelectHealth medication fee schedules that include: the MAC list for pricing of generic drugs, J-code fee schedules for use in physician offices, retail pharmacies, specialty pharmacies, home health and infusion centers.
Minimum Qualifications
Pharm D. degree or Masters degree from an accredited school of pharmacy. Degree will be verified.
State license to practice pharmacy and dispense controlled substances.
Five years of pharmacy practice experience in a managed care and hospital environment.
- and -
Five years of Pharmacy Benefits management experience.
Preferred Qualifications
Advanced degree in business management or healthcare administration.
+ Pharmacy experience in a managed care setting including an ASHP accredited managed care residency.
+ Strong health care systems orientation including: managed care, retail and hospital pharmacy, pharmacy contracting, pharmaceutical company contracting
+ Strong verbal and written communication skills.
+ Personal computer skills including word processing and spreadsheets.
+ Working knowledge of the laws and regulations in Idaho, Nevada and Colorado preferred. Experience working with regulators and policy makers at both the state and federal levels. Ability to analyze proposed regulations and legislation and understand potential impacts to our business and the market.
Physical Requirements:
SH only
Interact with others requiring employee to verbally communicate as well as hear and understand spoken information.
- and -
Operate computers, telephones, office equipment, and manipulate paper requiring the ability to move fingers and hands.
- and -
See and read computer monitors and documents.
- and -
Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.
Location:
SelectHealth - Murray
Work City:
Murray
Work State:
Utah
Scheduled Weekly Hours:
40
The hourly range for this position is listed below. Actual hourly rate dependent upon experience.
$76.97 - $110.90
We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.
Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers (https://intermountainhealthcare.org/careers/working-for-intermountain/employee-benefits/) , and for our Colorado, Montana, and Kansas based caregivers (http://www.sclhealthbenefits.org) ; and our commitment to diversity, equity, and inclusion (https://intermountainhealthcare.org/careers/working-for-intermountain/diversity/) .
Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
All positions subject to close without notice.
Source : Intermountain Health
