Job Description
Position Summary: The Director of Pharmacy Benefit Management (PBM) is responsible for overseeing and managing all aspects of the pharmacy benefit program for a Medicare Advantage Plan. This includes developing and implementing strategies to optimize medication use, managing formulary development, and ensuring compliance with all regulatory requirements. The role is remote, offering flexibility and the ability to work from anywhere.Key Responsibilities:Pharmacy Benefit Program Management:Oversee the design, implementation, and management of the pharmacy benefit program.Develop and maintain formulary and utilization management strategies to ensure cost-effective medication use.Monitor and analyze drug utilization trends and make recommendations for improvements.Regulatory Compliance:Ensure compliance with all federal and state regulations related to PBM and Medicare Advantage Plans.Stay informed about changes in regulations and ensure the organization adapts accordingly.Develop and maintain policies and procedures to ensure compliance and best practices.Clinical and Quality Initiatives:Promote medication safety and efficacy through the development of clinical guidelines and protocols.Lead quality improvement initiatives related to PBM.Collaborate with healthcare providers to optimize medication therapy management for members.Vendor Management:Manage relationships with pharmacy benefit managers (PBMs) and other vendors.Negotiate contracts and agreements to ensure favorable terms and conditions.Monitor vendor performance and address any issues that arise.Financial Management:Develop and manage the PBM budget.Identify opportunities for cost savings and revenue enhancement within pharmacy operations.Monitor financial performance and provide regular reports to senior leadership.Collaboration and Communication:Build and maintain relationships with internal and external stakeholders, including providers, payers, and regulatory agencies.Communicate effectively with executive leadership, board members, and other key stakeholders.Represent the organization at industry conferences, meetings, and events.Qualifications:Bachelor’s degree in Pharmacy, Healthcare Administration, or a related field; advanced degree (PharmD, MBA, MHA) preferred.Active pharmacy license in good standing is a plus.Minimum of 7 years of experience in pharmacy benefit management, with at least 3 years in a leadership role.In-depth knowledge of Medicare Part D regulations and PBM operations.Strong strategic planning, analytical, and problem-solving skills.Excellent communication and interpersonal skills.Proven track record of driving quality improvement and cost-saving initiatives.Vaco
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