UCare

Pharmacy Supervisor - Regulatory

Employer
UCare
Location
Minneapolis, Minnesota
Posted
Dec 29, 2021
Closes
Jan 29, 2022
Ref
2728
Category
Healthcare
Employment Status
Full Time
Health Care that Starts with You!

Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota's leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs.

UCare is growing in size, membership, products, geographic coverage, and employees. We're an organization that's going places. Be part of a team that cares about you, be part of UCare.

Rewards

Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You'll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis just minutes from major freeways and retail centers.

At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.

www.ucare.org/careers/

EOE/AA

ABOUT UCARE

UCare offers Medicare, Medicaid, Individual and Family health plans - powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives.

WORKING AT UCARE

Working at UCare is more than a career; it's a mission. A mission that defines us as professionals, unites us as an organization and shapes how we interact with our members and each other. Employees join UCare and stay because of the opportunity to have a purpose-driven job.

Our strong culture has established UCare as a Star Tribune Top 150 Workplace for 12 consecutive years since the awards program began. It's a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences. Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.

PHARMACY SUPERVISOR - REGULATORY

Work Location: Standard or hybrid

The health and safety of our employees, members, providers, and our community is our highest priority. Therefore, all new employees are expected to be fully vaccinated against COVID-19 prior to starting at UCare, subject to limited exceptions such as for a sincerely held religious belief or for medical reasons.

Position Description

This position is responsible for supporting UCare's Pharmacy department in responding to regulatory audits, interpreting new regulatory guidance, and overseeing delegated coverage functions by the Pharmacy Benefit Management Company (PBM) and Medical Drug Vendor. This position will oversee the regular monitoring and oversight activities to ensure compliance with pharmacy benefit and medical benefit requirements. This position is also responsible for overseeing the UCare pharmacy case reviews (i.e., appeals and initial determinations) for pharmacy drugs and medical drugs. In this role you will collaborate with UCare departments to ensure strategic and compliance goals related to UCare pharmacy services are met.

• Oversee the process for internal pharmacy reviews including medical drug initial coverage determinations and pharmacy and medical drug appeals reviewed internally at UCare.

• Lead UCare's Pharmacy department in responding to regulatory audits and compliance inquiries. Support end-to-end resolution of audit and compliance items from engagement to corrective action plan completion. Coordinate and assist in leading response to pharmacy regulatory audits with internal Government Relations and Compliance departments.

• Review and interpret new regulatory guidance (e.g., HPMS memos) and its applicability to UCare pharmacy processes. Ensure UCare is prepared to meet new regulatory requirements by communicated deadlines.

• Oversee clinical review activities delegated to PBM and Medical Drug Vendor.

• Oversee monitoring activities and reporting to ensure appropriate compliance with regulatory requirements and specific clinical initiatives. Evaluate the clinical pharmacy benefit to ensure that it meets regulatory (e.g., CMS, DHS, and MDH) requirements.

• Oversee required regulatory submissions for all regulators (e.g., CMS, DHS, MDH).

• Provide clinical pharmacy support for NCQA initiatives, projects, and audits.

• Develop and maintain Policies and Procedures related to clinical pharmacy processes.

• Collaborate with UCare Departments to address member specific pharmacy issues.

• Participate on various UCare Committees and Product Teams.

• Supervise and provide oversight of clinical pharmacists. Recruit, interview and select new staff. Coordinate new employee orientation planning, maintenance of materials and collaborate with leaders for on-going staff development and training.

• Other projects and duties as assigned.

Education

Bachelor of Science in Pharmacy required. PharmD preferred. Current Minnesota pharmacy licensure required.

Required Experience

Three years' experience in a clinical pharmacy role, with at least two years' experience in a managed care and/or PBM company. One year supervisor or leadership experience. Knowledge of Medicare, Medicaid, and/or Individual regulations.

Preferred Experience

Five or more years' experience in a managed care and/or PBM organization. Experience with Medicare Part D, Medicaid, and Health Exchange pharmacy benefit administration. Demonstrated Project Management experience.

THE UCARE DIFFERENCE

The UCare difference is our people power - employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions, and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, helps you build on your strengths and gives you the opportunity to truly make a difference, we invite you to apply.

As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.

JOB POST DATE: 12/28/2021

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