MaineCare Associate Director of Pharmacy

Location: Augusta,Maine,United States

Department of Health and Human Services (DHHS)

Public Service Manager III

Opening Date: February 12, 2025

Closing Date: March 5, 2025

Job Class Code: MA34 (Confidential)

Grade: 34

Salary: $84,697.60 - $120,265.60 per year

Position Number: 02000-2939

Location: Augusta

Core Responsibilities:

As MaineCare’s Associate Director of Pharmacy, you will advise on coverage and the development and implementation of pharmacy strategy relating to utilization management, reimbursement, and drug rebate management for both point-of-sale retail and medical (i.e. physician-administered drugs) pharmacy benefits. You will oversee the Pharmacy Benefit Administrator (PBA) and associated contract (worth $29 million), which includes the operation of MEPOPS and the associated long-term procurement strategy for these services. You will serve as a member of the OMS Senior Management Team (SMT) to advise the MaineCare Director and share in decision-making and leadership of MaineCare programs, services, and operations. You will report to the MaineCare Director and will work under limited supervision. Your goals and duties will include: 

•    Provide leadership and management for the 11-member Pharmacy unit, ensure that the team is aligned with OMS and DHHS business needs and priorities and to set standards for effective and efficient program administration. Assign and monitor the work of direct reports to ensure that work is appropriately prioritized, scheduled, and executed by agreed-upon plans.

•    Overseeing the current PBA contract, including holding the PBA vendor accountable for contract terms and effective use of state/federal resources to support members with appropriate, cost-effective, timely access to critical medications.

•    Developing and implementing a PBA contract procurement strategy and timeline in alignment with federal regulations and standards, state procurement processes, and the broader MaineCare strategy for the Medicaid Enterprise System. 

•    Oversee an integrated approach to managing retail and medical pharmacy benefits, including utilization management initiatives such as a biosimilar preferred drug list, and strategies for managing requests for high cost drugs to ensure member access to necessary care and reduce cost exposure to the state to the extent possible.  

•    Planning and overseeing data collection, reporting, and program review and assessment to support efficient delivery of quality programs and services and compliance with applicable state and federal laws, regulations, policies, procedures, and performance standards. 

•    Collaborating with internal and external partners to navigate and gather feedback on complex policy and operational challenges, including pharmacies, hospitals, and other provider organizations; individual pharmacists and physicians; advocacy organizations; and legislators.

•    Developing planning documents, briefs, and recommendations to implement clinically effective drug treatments and cost containment where appropriate.

•    Overseeing the Drug Utilization Review (DUR) committee to improve member access to safe and cost-effective drug treatments.

•    Evaluating operational processes for efficiency, effectiveness, and potential improvements.

•    Managing the PBA’s provider and member complaint escalation to promote high-quality customer service. 

•    Implementing and tracking the progress of pharmacy-related legislation and budget initiatives.

•    Managing and responding to all pharmacy-related audits.

•    Working proactively with MaineCare’s policy unit on pharmacy-related policy development and implementation.

•    Using sound judgment and strong problem-solving skills to provide direction and make decisions on escalated issues, questions, and decisions from the Pharmacy team.

•    Professionally representing the team, office, and Department on pharmacy-related issues.

Minimum Qualifications:

To qualify, your background must include a 10-year combination of education and experience in pharmaceutical operations, pharmaceutical policy, health care administration, health care systems administration, or public policy, which provides significant related experience managing staff and ongoing operations. A current Pharmacist license and/or professional degree in public policy or administration, healthcare administration, business, or other comparable field focusing on health or pharmaceutical policy is preferred. 

The background of preferred candidates will demonstrate the following competencies: 
 
1.    A proven ability to oversee and manage the