- Audit-ready culture that emphasizes aligning member needs with high-quality, compliant pharmacy health plan operations
- Strong foundational Clinical vision tied to purpose and knowledgeable team of experienced pharmacy and health plan professionals who are committed to executing the strategies and programs that enable our members to experience a life well-lived
- Starting annual salary range, based upon skills and experience: $140,000-172,000 plus robust total rewards package
- Develop and implement strategic formularies and pharmacy programs to improve medication adherence, reduce costs, and enhance patient satisfaction.
- Collaborate cross-functionally internally and with external partners to identify, develop, prioritize, and implement outcome-based pharmacy activities:
- Quartz Pharmaceutical Care Management (PCM) Program
- Quartz Medical Drug Pharmacy Programs.
- Quartz Pharmacy Programs.
- Clinical Client Consultancy, Sales Support and Client On-boarding.
- Trend Management and Reporting.
- Provides leadership, support and guidance to Team, Pharmacy Department, Clinical Services and Quartz Health Plan.
- Develop and manage SOPs to govern the Pharmacy Programs and Strategy area.
- Serve as subject matter experts and provide expertise and assistance to Quartz departments including Customer Service, Sales, Underwriting, Provider Relations, Marketing, Finance, Medical Management, Behavioral Health and Operations.
- Ensure compliance of pharmacy benefit management activities with appropriate regulatory (OCI, DOI, CMS, DHS) and accreditation (NCQA) organizations in collaboration with internal areas including assessment of new government program requirements and determine appropriate compliance strategies and implement.
- Bachelor's Degree in pharmacy is required
- Doctorate Degree in Pharmacy is preferred.
- 5+ years of Health Plan or PBM experience along with people management experience
- 3+ years of program director/manager level experience
- Knowledge of contracts, applications, products, and regulations (Medicare, ACA, Commercial).
- Knowledge of benefit systems and claims processing systems.
- Strong interest in clinical and operational pharmacy services excellence and leadership.
- Strong analytical and data interpretation skills.
- Familiar with clinical program components, formulary designs, and prescription drug benefit trends
- Able to demonstrate skills in prioritization, problem solving & critical thinking, team building, decision making, time management and strategic planning.
- Pharmacist licensure in WI, IL, MN, or IA is required.
- Excellent organizational and interpersonal skills.
- Excellent verbal and written communication skills.
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Director, Pharmacy Programs - Madison, United States - Unity Health Insurance
Description
OverviewAt Quartz Health Solutions, we are revolutionizing the way healthcare is delivered and experienced.
Committed to excellence, innovation, and patient-centric care, we are seeking a dynamic and forward-thinking Director of Pharmacy Program and Strategies to join our passionate team.
If you are driven by innovation, thrive in a collaborative environment, and are passionate about making a meaningful impact on healthcare, we want to hear from you
As the Director, Pharmacy Program and Strategies, you will play a pivotal role in shaping and leading our pharmacy programs to optimize patient outcomes, enhance medication management, and drive cost-effective solutions.
You will collaborate cross-functionally with internal teams, external partners, and stakeholders to develop and implement innovative pharmacy strategies that align with our organizational goals and values.
Benefits:
This position has the flexibility to work in a hybrid environment, reporting regularly (at least quarterly) to our office in Madison, WI.
Hardware and equipment will be provided by the company, but candidates must have access to high-speed, non-satellite Internet to successfully work from home.
Quartz offers an excellent benefit and compensation package, opportunity for career advancement and a professional culture built upon the foundations of Respect, Responsibility, Relationships, and Resourcefulness.
Quartz values and embraces diversity and is proud to be an Equal Employment Opportunity, Affirmative Action employer.
All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity or expression, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.
