Sr. Pharmacy Director Medicare

POSITION SUMMARY

The MMP Pharmacy Director oversees a team Dual/SNP Pharmacy Directors that are responsible for the pharmacy services for Medicare/Medicaid Health Plans across the country. This position directs, supervises and coordinates the activities of the Health Plan Pharmacy Directors and is responsible for maintaining a strong management and operational team to support the Health Plan Leadership teams.

Fundamental Components:

* Expectations are to maintain and develop a highly effective leadership team; coach and mentor leadership team members to optimally utilize and improve skill sets, capabilities and performance outcomes; creates an atmosphere that promotes and encourages innovation and creativity. Identifies and evaluates workload and quality indicators and revises staffing responsibilities and mixes skill sets to ensure that we optimize the effectiveness of personnel. Oversight of pharmacy trends and works closely with Medical Management and develop drug utilization and formulary initiatives to optimize therapeutic outcomes, risk reduction and/or cost and revenue impact. Work in collaboration with the Senior Pharmacy Director to monitor and manage the operational administrative expenses and to develop the annual operational budget. Serves as a Pharmacy representative with Medical Management leadership team on selected organizational committees as appropriate for the Dual business.

2-3 years management, preferred experience in a managing Medicare-Medicaid programs

* 1-2 years experience in development of Medicare pharmacy benefits, formulary and programs guidelines

* Ability to develop goals, provide coaching and mentoring for staff development

* Excellent written and verbal communication skills; data analysis and report writing required

* 1-2 years experience in policy and program development preferred

* 1 year minimum experience working in a high volume call center

* Licensed pharmacists

* 2-3 years CMS audit experience

BACKGROUND/EXPERIENCE desired:

Pharm.D with at least 3 yr experience in Medicare managed care Ability to work collaboratively across the organization. Ability to conceive innovative ideas or solutions Excellent communication and relationship management skills Provides day-to-day leadership and management Assists Senior Pharmacy Director in collaborative efforts related to the development, communication and implementation

EDUCATION

The highest level of education desired for candidates in this position is a Doctor of Pharmacy.

LICENSES AND CERTIFICATIONS

Pharmacy/Registered Pharmacist is required

FUNCTIONAL EXPERIENCES

Functional - Management/Management - Operations/1-3 Years

Functional - Management/Management - Process and quality improvement/1-3 Years

Functional - Medical Management/Medical Management - Clinical coverage and policies/1-3 Years

Functional - Medical Management/Medical Management - Pharmacy/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User

Technical - Desktop Tools/Microsoft Word/1-3 Years/End User

Technical - Desktop Tools/Microsoft SharePoint/1-3 Years/End User

Telework Specifications:

Flexible telework / office-based schedule (must live near certain office location)

ADDITIONAL JOB INFORMATION

The Medicare/Duals Pharmacy team lead's key responsibilities -support the pharmacist overseeing the Duals plan -oversee all Duals-related pharmacy activities delegated to CVS Caremark -oversee the review and monitoring of PA and appeals activities -work closely with Aetna compliance -identify, communicate, remediate and resolve issues -communicate and develop plan to comply with CMS guidance updates -prepare and participate in CMS and state audits -assign a pharmacist with responsibility for quality, DUR, and Stars that meets regularly with the SAI team -create a standard benefit build for all Dual Plans to allow for consistency and oversight opportunities

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

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Employment Type Regular Career Band Description Management