- Partners with appropriate staff in the identification, sale and measurement of clinical program enhancements and better practices.
- Assists with legislative policy requests and provides timely information on current events and trends that includes benchmarking metrics.
- Creates and maintains ad hoc reports that meet customer needs.
- Communicates frequently and reports program progress, establishes priorities and maintains positive client relationship. Responds to client's requests for information.
- Assesses, investigates and resolves difficult issues to achieve customer satisfaction.
- Develops, implements and monitors project plan requirements and timelines, ensures all necessary support, tools and technology are available, and follows up as needed.
- Ensures application of best practices across contracts in meeting with business process owners and other appropriate stakeholders to identify the project & aposs goals, objectives, critical success factors and success measures.
- Works closely with Operations, Rebate and other internal departments to ensure consistent delivery of approved programs to the client and results of programs, as well as overall metrics to monitor performance of the program.
- Ensures operations are standardized at the fullest extent possible.
- Provides overall project coordination for the contract & aposs clinical functions.
- Ensures revenue goals and administrative expenses are managed.
- Develops strong relationships with key contacts at client level and contacts within Magellan that are supportive of the achievement of increased revenue goals.
- Ensures all customers are fully satisfied with services and results.
- Provides guidance and assistance in the coordination of implementation of new solutions and products and serves as liaison between the company and customers as needed.
- Assists in modifying implementation approaches within budget and operational framework.
- Act as primary point of contact with the State, MCOs, and other Stakeholders. Responsible for all Vendor requirements under the SOW and Contract.
- Oversee Vendor business processes and documentation.
- Interact, communicate, and coordinate to ensure continuity of pharmacy unit activities and responsibilities.
- Accountable for development, coordination, and publication of communication with outside entities, e.g., written provider communications, pharmacy related web content, etc.
- Coordinate and communicate with provider associations, and other outside entities, including the general public.
- Initiate and manage system change requests and documentation.
- Accountable for appropriate representation at pharmacy-related Boards and Committees (e.g., Nevada Board of Pharmacy, DUR Board, Silver State Scripts Board, Medical Care Advisory Committee, etc.).
- Acquire, analyze, and maintain information regarding pharmacy benefit management "best practices".
- Responsible for reviewing and approving all reports that are the responsibility of the Vendor.
- Extensive knowledge of Medicaid and NMAP claims processing and pharmacy benefits management.
- At least three (3) years of management experience with government or private sector health care payer.
- Excellent communication and public speaking/presentation skills.
- Practical knowledge and experience in project/account management.
- Resides in Nevada.
- Bachelor's Pharmacy, PharmD preferred.
- Nevada licensed registered Pharmacist in good standing.
- 8+ years of pharmacy experience.
- 5+ years of experience in Pharmacy Benefits Management (PBM), Health plan or Medicaid clinical customer service.
- Working knowledge of MS Office Suite and COGNOS or comparable.
- Proven ability to plan, organize, schedule, direct, control and monitor project activities.
- Project management experience and knowledge of health plans, PBMs or Medicaid required.
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Director, Clinical Account Services - Home, United States - Prime Therapeutics LLC
Description
Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.Job Posting Title
Director, Clinical Account Services - Remote Nevada
Job Description Summary
Plays a key role in various clinical pharmacy accounts: overseeing the overall clinical activities for various clients and up selling additional clinical services and ensuring renewal of the account.
Responsible for working with Account Managers in identifying common customer problems that require clinical solutions, and facilitating the implementation and monitoring of clinical solutions in support of our clients' goals to reduce expenses and improve care.
Serves as facilitator and mentor to the clinical liaisons for assigned contract(s).Assists Account Managers with managing overall client relationship and driving the adoption of recommended clinical solutions as well as assisting Account Managers in managing the P&L of the account in order to meet targeted profitability.
Understands that the financial impact of all clinical recommendations is essential for both the client's cost of care and the overall administration of the programs.
Activities address impact on customers, operations, program integrity, pricing, quality and satisfaction. Develops and tracks appropriate metrics that monitor the quality and care cost impact of the clients' program.Provides guidance, assistance and mentoring to assist the Account Manager staff in attaining goals.
Requires communication across all departments and an understanding of the strategic impact of the programs to customers and clients and extensive knowledge of how the programs integrate with other clinical initiatives.
As a collaborative partner with our customers, must have expertise with data management and overall healthcare trends specific to the Medicaid population.
Job DescriptionClient Specifics:
Requirements:
Work Experience - Required:
Pharmacy
Work Experience - Preferred:
Education
Education - Required:
Bachelors - Pharmacy
Education - Preferred:
PharmD - Pharmacy
Certifications
Certifications - Required:
RPH - Registered Pharmacist - Pharmacy - Pharmacy
Certifications - Preferred:
PharmD - Doctor Of Pharmacy, State Licensure - Pharmacy - Pharmacy
To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail.
We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law.
Positions will be posted for a minimum of five consecutive workdays.
