Director, Pharmacy and Clinical Consulting

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As the Director of Pharmacy and Clinical Consulting, you will participate in the strategy development and establishment of business goals to ensure alignment with our department’s long term strategic objectives, core management program capabilities, and continued close partnership with functional areas across the company. The Director will oversee the development of pharmacy clinical quality and provider engagement programs, clinical consulting support for account management teams and customers, pharmacy product, and talent management to meet the evolving needs of the business.

This role provides people, program, and strategic leadership in close partnership with the VP, Pharmacy and Clinical Consulting and in close collaboration with their peer Director, Pharmacy and cross-functional departments to drive business outcomes.

What you will do:

• Set strategic direction for program development appropriate outcomes related to access, affordability, quality and experience.  

• Lead the clinical consulting efforts with customers around their pharmacy and medical benefits, trends, and programs. Interface with sales/account management, brokers, clients/customers and Premera General Managers.

• Develop strategies for measuring and managing appropriate pharmacy utilization, negotiates and monitors contracted vendors, contributes to building physician relationships aimed at quality pharmaceutical care, and stays abreast of pharmacy benefits manager and payer industry environment.

• Collaborate on the development and implementation of comprehensive strategies for drugs across both pharmacy, medical benefits, including specialty, biosimilar, cell and gene therapies etc. 

• Design and implement provider engagement program, generating insights,  tactics to deliver managed and improve pharmacy trend and outcomes. Build strong external relationships with large multi-specialty provider groups.

• Develop and maintain effective relationships with actuarial, health care economics, sales, corporate communications, operations, product strategy and development, legal, underwriting, finance, customer service, congressional and legislative affairs, IT, and senior management to enhance collaboration for successful business outcomes.

• Oversite, direction for pharmacy clinical programs and associated compliance with regulatory  (e.g. State, Federal) and quality accreditation standards (e.g. HEDIS, NCQA) for all lines of business (Commercial, Medicare Advantage, Individual, HMO, FEP). 

• Develop and manage budget to anticipate and meet business needs.

• Oversee the Clinical Consulting team, including Pharmacists, Nurses, and support resources.

• Lead multidisciplinary teams in core areas of responsibility: Clinical Consulting team, comprised of pharmacists and nurses, Pharmacy Product , Pharmacy Clinical Quality  and Medicare Advantage

• Attract, retain, and coach a high performing team, providing individuals growth opportunities to meet the evolving needs of the business.

• Participate in cross functional projects with multiple internal and external stakeholders and partner on execution.

What you will bring:

• Bachelor’s degree in business or healthcare or four years’ relevant experience.

• Ten years of experience in a large health plan, medical management or pharmacy management organization that includes care, case and pharmacy management, health and wellness and risk management. (Eight years of experience in this area if candidate holds a