Director Pharmacy Health Engagement

Company :

Job Description : 

JOB SUMMARY

This job directs the development, implementation, oversight and continuous improvement of the systems, processes, policies and staffing necessary to ensure cost effective and consistent pharmacy case management, medication therapy management, member-facing pharmacy quality strategic initiatives, and delivery of targeted member facing pharmacy outreach for a specific segment of the Organization's members and/or specific health management products and services.  Ensures attainment of client and/or market-specific operational, clinical, and financial commitments and performance guarantees in addition to improved levels of member and provider satisfaction with the services with the goal of ensuring optimal member outcomes lowering care costs associated with drug therapy. Participates as a key driver of the development and execution of corporate strategies for the effective delivery of proactive, innovative and engaging medication management services.  Uses internal analyses and external benchmarking to remain market-competitive and to continuously enhance the services being offered to both group clients and individual members. Specific focus on helping members manage medications across the continuum of care in a high quality, effective and cost-efficient manner while tracking and being responsible for outcomes. Exhibits a passion for patient care and commitment to providing high-quality pharmacy services that optimize health outcomes aligned to Highmark’s Living Health Strategy and product-led operating model. 

ESSENTIAL RESPONSIBILITIES

• Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.  Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.

• Directs the development, implementation, monitoring and continuous improvement of the systems, processes, policies and staffing to ensure effective medication management services for a specific segment of Highmark’s membership (e.g., national, regional, Medicare Advantage, FEP, special programs, etc.). Includes analysis and determination and reporting of the clinical and financial value of all member outreach.

• Ensures effective processes, including the use of predictive models, for the proactive identification, assessment and engagement of members with targeted and complex drug therapy problems, and high-cost medication regimens

• Collaborates with: 1) Market leaders, and sales to develop and implement solutions for emerging market and client needs including the requirements of CMS; 2) Physician staff in market segment and/or in the clinical function to ensure continuous improvements in the delivery and effectiveness of services and improvement in member outcomes; 3) Product management to develop and deliver competitive pharmacy programs and solutions; 4)  the broader health engagement team to ensure a seamless member experience across Highmark’s multidisciplinary clinical teams; 5) other departments to ensure seamless integration of services and optimize patient care.

• Drives operational efficiency through implementation of technology solutions to automate tasks, optimize workflows, and improve data management.

• Uses benchmarking through scientific research, networking, and literature searches to continuously raise the expectations of performance and remain competitive with the product offerings of other health plans, PBMs, and medication management vendors.

• Develops and participates in strategic initiatives based on the business needs. Develops and manages the operational budget.

• Ensure that all staff are delivering services appropriate to meet member’s needs including social barriers and identification and removal of modifiable barrier that interfere with members attaining heath goals. Provide information on appropriate medication use, medication access, adherence, alternative treatment regimens, preventive and chronic care interventions and screening, and close all identified gaps in care related to medication management (quality/STARS metrics). Work to assist members in receiving evidence –based pharmaceutical care 

• Oversees development and implementation of policies and procedures that meet the changing business needs while ensuring compliance with all applicable CMS, URAC, NCQA, FEP, DOH and DOI standards and regulations. Complete all required reporting per compliance requirements in professional and timely manner.<