Director, Pharmacy Services, Government Programs Hybrid

Resp & Qualifications

PURPOSE: Director, Pharmacy Services is responsible for implementing the organization's pharmacy vision and strategic plan for government programs including Maryland Medicaid, Dual Prime Special Needs Plan (DSNP), and Medicare Advantage products. This role has oversight of pharmacy staff and develops and maintains collaborative relationships with clinical, administrative, and other key stakeholders including external vendors to ensure effective operations and value realization of pharmacy programs.

This role also serves as a key point of contact with the Maryland Department of Health (MDH) and U.S. Centers for Medicare and Medicaid Services (CMS).

• Provides oversight and support for the management of multi‑fascinated Pharmacy Services Government Programs to reduce pharmacy spend, total cost of care, and improve health outcomes. Supports programs from evaluation through implementation and value realization. Monitors and tracks program activity and performance and communicates outcomes to key stakeholders within the organization.
• Respond to the Maryland Department of Health (MDH), U.S. Centers for Medicare and Medicaid Services (CMS), and other federal and state agencies as directed by leadership. Assist in ensuring pharmacy related processes are carried out in accordance with MDH, CMS, and other federal and state requirements and guidance, including executive orders, regulatory requirements, and administrative rules. Prepare for annual submissions to and respond to other requests from MDH and CMS.
  
  Oversee the creation and maintenance of the website contents, member/provider/internal communications in accordance with NCQA, Medicare, and MDH requirements.
• Manages and directs staff, demonstrating effective performance management of team members and supports activities to maintain a high functioning team. Reviews staffing goals and expectations to ensure that each is consistent and adequate to meet department goals. Provides coaching and motivation to team members ensuring staff has appropriate tools and training. Plans and manages the departmental budget.
• Serves as a point of contact for Care Firsts PBM vendor and other strategic pharmacy vendor partnerships. Ensures vendors execute contract terms. Identifies and implements vendor programs based on Care Firsts needs such as quality initiatives, compliance, population health, and/or member/provider experience.
• Analyzes Medicare and Medicaid pharmacy and medical drug utilization data to identify trends and at‑risk populations; recommend and develop appropriate interventions; monitor and take actions on results. Identify business process improvements that are aligned with and supportive of business goals and objectives. Contribute to the development of dashboards that monitor critical data elements and track results for Executive Leaders. Identify actionable insights based on data and help ensure successful implementation of clinical savings.
• Develops, provides, and oversees formal written and verbal presentations and other communications related to clinical government pharmacy programs. Able to effectively present pharmacy information to key internal and external stakeholders at an Executive Level.

SUPERVISORY RESPONSIBILITY: This position manages people.

QUALIFICATIONS:

Education Level: Pharm.

D in Pharmacy.

Licenses/Certifications Upon Hire

Required:

• PHARMD - Licensed Pharmacist

Experience:

• 8 years Experience working in the healthcare industry with a focus on a pharmacy benefit administration.
• 3 years management experience.

Preferred Qualifications:

• Active Pharmacist license in Maryland, or the ability to obtain Maryland licensure within 6 months of employment.
• Minimum two years involvement in formulary development, drug use evaluation, and quality improvement activities.
• Experience with developing and implementing clinical programs.
• Experience with Medicare Part D and Medicaid guidelines and requirements.
• Completion of a pharmacy practice or specialty residency (PGY1 or PGY2).

Knowledge,

Skills and Abilities

(KSAs)

• Entrepreneurial, highly motivated, and collaborative.
• Ability to establish credibility and influence persons of all…