Pharmacy Manager

Summary: Provide PrimeWest Health with consultative services related to pharmacy operations, pharmacy utilization management (UM), Medicare Part D, and as otherwise specified below. 

• Reporting Accountability
• This position is responsible for meeting the following regulatory, contractual, or other requirements on behalf of PrimeWest Health:

   

  1. Ensure knowledge of State, Federal, and regulatory requirements pertaining to pharmacy operations
   

   

  Role and Key Responsibilities
  Assist the Director of Quality & Utilization Management and PrimeWest Health staff in the following as needed:
  1. Monitor Medicaid and Medicare Parts B and D pharmacy utilization, including medication reviews for beneficiaries
  2. Consult with Compliance & Auditing department or assigned contact on Medicare Part B and D issues; discuss issues and make recommendations
  3. Serve as primary contact for PrimeWest Health’s pharmacy benefit manager (PBM), develop and communicate recommendations for improvement identified through report analysis and during annual delegation assessment, and monitor activities conducted on PrimeWest Health’s behalf including formulary and pharmacy benefit changes
  4. Perform utilization review for determining medical necessity/appropriateness for pharmacy reviews according to State Statute
  5. Collaborate with other PrimeWest Health departments and provide professional advice and recommendations for Population Health Management nurses, chronic care improvement programs (CCIP), quality efforts, medication management therapy programs (MTMP), and step therapy and tier programs
  1. Review specific member pharmacologic agents as they relate to chronic disease management and make recommendations Review pharmacy claims and utilization for appropriateness Provide recommendations to care coordinators regarding population health management care planning activities Review and update PrimeWest Health’s pharmacy-related policies and procedures to meet State, Federal, and National Committee for Quality Assurance (NCQA) pharmacy-related requirements Review and update PrimeWest Health’s medication therapy management (MTM)-related policies and procedures to meet State and Federal MTM-related requirements Communicate with providers (both pharmacists and physicians) about formulary alternatives Act as PrimeWest Health’s pharmacy liaison with PBM in regards to pharmacy recommendations Monitor changes in PrimeWest Health’s formulary and communicate need for member and provider notification back to PrimeWest Health Care Coordination staff Provide clinical-based evidence and cost analysis of specific therapeutic classes of drugs Author pharmacy/physician-oriented and pharmacy-related newsletters/articles, if requested Collaborate with PrimeWest Health’s Claims staff regarding pharmacy-related procedures Review PBM’s quarterly pharmacy UM reports and make recommendations as indicated Assist with conducting annual PBM audit, development and review of the annual report, and any corrective action plan/oversight development Review all Centers for Medicare & Medicaid Services Health Plan Management System (CMS HPMS) pharmacy-related notifications and intervene with PBM when indicated Collaborate with PBM on regulatory projects and develop internal monitoring and workflows for said projects Collaborate with Behavioral Health staff on identification and management of Restricted Recipient Program (RRP) and Drug Management Program (DMP) members Serve on the Universal Pharmacy Policy Workgroup (UPPW)
   

   

  General PrimeWest Health Responsibilities
  1. Abide by the PrimeWest Health Code of Conduct
  2. Comply with all PrimeWest Health policies and procedures
  3. Comply with the Health Insurance Portability and Accountability Act (HIPAA) and all other privacy laws
  4. Be familiar with building safety procedures and alert maintenance if something requires attention
  5. Keep public areas of the department and office neat and clean
  6. Conduct other responsibilities and activities as needed and assigned
  Professional Competencies
  1. Organization and time management skills
  2. Ability to work effectively with minimal supervision and structure
  3. Knowledge of clinical standard and outcomes
  4. Assessment, goal-setting, intervention development, and follow-up skills
  5. Ability to perform critical analyses, plan and organize, and promote client and family autonomy
   

   

  Educational Requirements and Required Qualifications
  1. Doctor of Pharmacy (PharmD) degree. UM, Population Health Management (PHM), MTM, and managed care organization (MCO)/PBM experience beneficial.
  2. Flexibility and ability to handle multiple tasks. Demonstrated organizational skills and attention to detail. Ability to work effectively with a variety of people both within and outside of the organization. Excellent verbal and written communication skills.
  3. Demonstrated knowledge of, and proficiency in, Word, Excel, and Outlook required. Experience in PowerPoint is a plus.
  4. Ability to sit at a desk or computer station most of the time. Ability to occasionally lift and/or carry such articles as file folders and small boxes up to 20 pounds. Some travel, including overnight travel, required.
  Appropriate Licensure and Certification Requirements
  1. Must possess current and unrestricted pharmacy license
  2. Must attend continuing education sessions each year to support license requirement
  Collaborative Efforts with Other Departments
  1. Administration
  2. Business IT & Claims Administration
  3. Care Management
  4. Corporate Compliance & Auditing
  5. Information Systems & Technology
  6. Member & Provider Services
  Supervision
  1. Act as supervisor to Credentialing & Pharmacy Specialist
  2. Comply with all PrimeWest Health personnel policies and procedures
  3. Model leadership, integrity, and honesty in communications with other departments and PrimeWest Health staff

  This position description is not to be construed as an exhaustive statement of essential functions or responsibilities.