Senior Director - Pharmacy Operations - Plans

Position: Senior Director - Pharmacy Operations - Avera Health Plans
Location: Baltic

Location:

Avera Health Plans

Worker Type:

Regular

Work Shift:

Primarily days with possible weekends/evenings/holidays (United States of America)

Position Highlights

You Belong at Avera

Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.

A Brief Overview The Senior Director of Health Plan Pharmacy Operations will provide overall leadership and pharmacy direction across all lines of Avera Health Plans business. This includes driving delivery of the pharmacy program to enhance affordability for both pharmacy and medical benefit drugs as well as program optimization for self-funded clients.

Will work closely with executive leadership across multiple areas including Sales, Product, Customer Service, Provider Network, and multiple health system partners to exceed customer expectations. In addition, the Senior Director of Health Plan Pharmacy Operations ensures that Avera Health Plans PBM meets or exceeds commitments for service and quality and drives member and physician engagement with pharmacy services to measurably improve satisfaction.

Will be responsible for thought leadership in pharmacy innovation to improve key quality and service results and will build, inspire, and engage a high-performance team to serve Avera Health Plans members and customers. Will maintain a solid understanding of system strategies and knowledge of the marketplace and incorporate these concepts into an overall medication and pharmacy services plan.
What you will do

• Develop and execute pharmacy strategies that align with the corporate and divisional objectives. Strategies focus on developing and defining procedures and systems to support and achieve high pharmacy carve-in rates, and long-term goals and measures that are consistent with Avera Health Plans strategy.
• Cascade and communicate strategy and initiatives to Avera Health Plans and Avera Health business owners, team members, customers, and stakeholders. Provide strong leadership to motivate team and build trust. Provide strategic oversight to the Pharmacy & Therapeutics (P&T) committee as needed.
• Focus on delivering, in aggregate, the lowest net spend and trend through greater engagement with providers and members, targeted clinical programs, and an outsourced Pharmacy Benefits Manager (PBM) relationship.
• Lead the design and implementation of continuous improvements and enhancements of the Pharmacy program (including the benefit designs, formularies, etc.) using data and analytics. Assure lowest net spend and trend vs. market competitors while optimizing members pharmaceutical value and improving efficiency and service levels.
• Provide pharmacy direction and input to cross-functional teams to inform product development and innovation; provide pharmacy subject matter expertise and guidance regarding benefit design/redesign to ensure efficient pharmacy and medical benefit drug spend.
• Lead and manage collaboration with the Sales team to support the renewal, RFP, and new sales customer activities. Provide consultation to ensure appropriate pharmacy and medical drug benefit strategies are recommended, presented, and implemented.
• Develop, maintain, and strategically leverage strong rapport with external relationships such as PBM, local pharmacy associations, provider groups, employer groups and brokers. Ensure market competitive PBM and Specialty Pharmacy results while focusing on developing long- term value for customers through clinical pharmacy program innovation. Provide leadership and oversight of relationships with legislative and regulatory bodies.
• Responsibilities include interviewing, hiring, developing, training, and retaining employees; planning, assigning, and leading work; appraising performance; rewarding and coaching employees; addressing complaints and resolving problems.

Essential Qualifications The individual must be able to work the hours specified. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.
Required Education, License/Certification, or

Work Experience:

• Pharmacist - Board of Pharmacy An active license in the state of practice Upon Hire
• Pharmacist - Board of Pharmacy Pharmacist - other states as required upon request
• Pharmacotherapy Specialty Certification (BCPS) - Board of Pharmacy Specialties (BPS) Upon Hire
• 4-6 years Progressive leadership experience within a health plan or PBM.
• 7-9 years Healthcare industry,…