Manager, Clinical Pharmacy Services, Health Plan

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We’re proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint. 

Work Shift:

8 Hours - Day Shifts (United States of America)

Scheduled Weekly Hours:

40

Union Position:

No

Department Details

Summary

The Manager works closely with Health Plan providers and staff to coordinate Pharmacy Benefit services and promote quality and cost effective outcomes. Interacts with members and providers to optimize member services. This position supervises the clinical aspects of Health Plan Pharmacy department operations to include integration with medical management and oversees the formulary management process, drug utilization reviews, and the pharmacy rebating process.

Job Description

Directly supervises and manages Health Plan Pharmacy Services support staff to ensure work assigned is completed in an accurate timely manner. Leads the Health Plan Pharmacy and Therapeutics Committee formulary evaluation process to manage formulary activities in a prudent, cost effective manner. Leads the development of integrated clinical pharmacy programs and services in support of goals and objectives. Provides Utilization Management services for member or prescriber requests for Pharmacy Prior Authorizations and Formulary Exception Requests. Manages communication of changes and large scale interventions to providers, members and employers in a time-sensitive and effective manner. Oversees the development, distribution, and evaluation of member, group, and provider educational materials to ensure accuracy.

Oversees the Badgercare Pharmacy Lock In Program to manager Health Plan Badgercare members on state directed narcotics programs. Manages pharmacy department participation in NCQA accreditation activities, HEDIS evaluations, CMS Best Practices, and other similar types of activities to sustain high quality performance. Oversees pharmacy department participation in the VIPS fraud, waste, and abuse process and the Health Plan Special Investigative Unit team to reduce waste and ensure member safety. Serves on integrated health plan workgroups with the mission of identifying opportunities for quality improvement, cost savings, and increased member satisfaction.

Qualifications

Bachelor of Science Degree in Pharmacy required. Doctor of Pharmacy degree, a pharmacy residency, board certification, or working toward any of the above preferred.

Two years’ experience in managed care pharmacy, either working in a health plan or PBM environment plus one year in a supervisory or management position. Experience in a community pharmacy practice, ambulatory care clinical pharmacy, and/or geriatrics is preferred.

Must have current license to practice pharmacy in the State of South Dakota. Pharmacist license in the State of North Dakota required within four months of date of hire into position. Pharmacist license in the State of Minnesota required within eight months of date of hire into position.

Sanford is an EEO/AA Employer M/F/Disability/Vet. 

If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to talent@sanfordhealth.org.