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Providence Health & Services Pharmacy Director in Washington

Description:

Providence St. Joseph Health is calling a Pharmacy Director to our location in Beaverton, OR. This position is a hybrid role that will be working a combination of in office and remote.

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We are seeking a Pharmacy Director who will report directly to the AVP of Pharmacy, is a member of the Pharmacy Senior Leadership Team (PSLT), and is accountable for visioning and leading Providence Health Plan pharmacy program strategy, development and implementations, including: Clinical Pharmacy Programs, Pharmacy and Therapeutics Committee, Formulary, Pharmacy Rebate Management, and Pharmacy Systems Administration and Emerging Technologies. The Director supports the AVP of Pharmacy in pharmacy benefit administration and strategy delivered through Providence Health Plan.

Major Challenges:

  1. Decisions and collaboration with multiple outside vendors, staff, key stakeholders - both internal and external in a meaningful way that inspires and gets results.

  2. Escalating prescription drug costs in the face of expanding technology and clinical evidence.

  3. Direct to consumer marketing of prescription drugs by pharmaceutical industry, requiring balancing information provision to prescribers and members to allow for meaningful decision making and choices.

  4. Rapidly changing healthcare environment and priorities with ever decreasing resources to allow 'open formulary access'.

  5. Providing for the special medication needs of our medically indigent and fragile populations, including the Medicare & Medicaid population.

  6. Meeting and exceeding ever changing regulatory requirements that have direct impact on administration of prescription drug benefits.

  7. Complexity of health care services administration and payer practices in a highly regulated field responsible for ultimately making decisions that impact the health, wellness, and disease management of 650,000 people in our 5-states footprint and beyond. Decisions of this position impact many hundreds of thousands people, but each individual must take into account the needs of the one in the context of the contracted services we provide to each person individually and to their employer or public program payer group.

In this position you will have the following responsibilities:

  • Evaluates, reviews, negotiates and manages such pharmacy contracts and pharmacy provider relations programs as may be necessary in a managed care environment utilizing assigned staff.

  • Evaluates, develops, prioritizes, implements, manages, and oversees such programs as needed to assure the availability of an ambulatory formulary management program and related evidence based drug therapy utilization initiatives.

  • Plans, controls, leads, directs, and manages such business relationships and programs that are necessary for successful pharmacy program management.

  • Pharmacy program management includes pharmacy benefit management companies (PBMs), third party administrators (TPAs, electronic prescription claims adjudicators, internal manager, pharmacist, nurse, and technician supervision & management, and such other activities that are necessary to provide necessary oversight and direction to a successful health plan pharmacy program.

  • Plans, controls, leads, directs and modifies new and established pharmacy projects - including cost saving pharmacy programs - that assist Providence Health Plan in meeting its financial and quality goals.

  • Recommends and participates in outpatient prescription drug benefit decision making and manages development of systems that can impact overall drug costs and trend.

  • Directs the provision of 'member at risk programs' and medication compliance and management systems in consultation with physicians and pharmacists.

  • Directs, manages, and supervises Pharmacy Services Department within Providence Health Plan. Employees supervised include pharmacy technicians, clinical pharmacy coordinators/business analysts, clinical pharmacist specialists.

  • Directs rebate strategy and performance management as a means by which to manage prescription drug trend.

  • Directs and manages Drug Utilization (DUR), medication recall programs, adverse drug reaction reporting systems, medication management initiatives for high risk members/patients in a manner consistent with the scope of the Pharmacy Director position.

  • Directs the development, implementation, and monitoring of pharmacy network management program, including pharmacy network pricing.

  • Participates on the Ambulatory Pharmacy and Therapeutics Committee (P&T) as well as the Quality Management Standards Committee, QMM Steering Committee and such other operational and/or programmatic committees and workgroups as may be necessary to fulfill the requirements.

  • Directs prioritization, development and implementation of a drug prior authorization program and various drug therapy initiatives.Directs development of step therapy protocols, prescription utilization guidelines and medical & pharmacy policies.

  • Directs, monitors and maintains quality of Pharmacy Services according to standards developed and approved by the Quality Management Standards Committee.

  • Directs, develops and communicates medication management needs as well as, ambulatory pharmacy issues and opportunities to health system pharmacy directors and medical directors in a manner that promotes and supports quality of care initiatives as well as stewardship initiatives.

  • Directs and coordinates the provision of physician education, monitoring, and profiling tools geared toward enhancing the provision of quality cost-effective medication management, as well as member drug usage profiling.

  • Directs and manages auditing of prescription claims processing, as well as J-code and specialty injectable medication provision.

  • Oversees such programs and processes as may be necessary to assure accurate, quality provision of pharmacy services administered under the medical portion of the health plan benefit.

  • Direct and Collaborate with Health System communications and regulatory entities pertaining to pharmacy and medication use.

  • Directs and responds to marketing RFPs regarding pharmacy benefit requests and contractual changes.

  • Directs and determines data analysis and utilization in collaboration with analysts, medical directors, financial analysts, and underwriters to assure meaningful use and interpretation of prescription drug data.

  • Directs and decides, collaborates, and identifies opportunities for case management, concurrent review, and disease management to obtain essential clinical pharmacy coordinator services or consultation in those arenas or situations requiring the expertise of a pharmacist.

  • Directs and decides, collaborates, and identifies methodologies and systems for financial management of pharmacy program spend. Such activities are taken on in cooperation with Informatics and Risk & Reimbursement (Finance).

  • Decides, collaborates, and identifies and implements opportunities to enhances overall PHS drug therapy management systems from both a quality and cost perspective. This is done by working with other health system pharmacy directors, medical directors, and key programmatic or department directors.

  • Sponsors Pharmacy Agile Information Services Team.

  • Leads Managers & Senior Managers in pharmacy resource allocation and prioritization.

Qualifications:

Required qualifications for this position include:

  • PharmD

  • Post-graduate PGY-1 & PGY-2 residency

  • Current licensure without sanctions by Oregon State Board of Pharmacy or eligible to meet requirements before employment

  • 10 or more years experience in ambulatory or acute care pharmacy practice with responsibility for drug therapy evidence assessment and/or formulary management, as well as direct consultation and presentation of medication information and recommendation to physicians and/or patients.

  • 5 years Managed care pharmacy experience

  • 8 years Progressively responsible experience in managed care or ambulatory care leadership including direct supervision and successful development of individual contributors and front line managers.

  • Demonstrated experience must also include the following core areas: contracting; pharmacy benefit administration and rebate management; pharmacy medical policy prior authorization, prescription benefit design; home infusion, hospice; specialty injectable medication management, medication case management strategies, and collaboration with various disciplines to assure the provision of coordinated care utilizing evidence-based best practices.

  • 3 years in vendor management oversight and performance.

  • Experience working with pharmacy information systems and collaboration with IS divisions.

  • Experience working with complex pharmacy and medical diagnoses data sets in pivot tables and Tableau in consultation with highly skilled analysts responsible for using these data sets to inform reporting that leads to decisions and prioritization of high value work and initiatives that achieve desired clinical, utilization, and financial outcomes.

  • Operational and clinical experience in the key internal and external relationships and strategies necessary to effectively manage pharmacy spend.

  • Comprehensive negotiation and contractual management experience in participating pharmacy network development & retention, electronic prescription claims adjudication, prescription rebate revenue processes & retention, clinical pharmacy service contracts, pharmaceutical company oversight, and such other oversight necessary to administer benefits for managing prescription and other medication use within managed care setting.

  • Comprehensive experience in managing an ambulatory formulary as well as programs and systems for drug use evaluation, medication management initiatives, adverse drug reaction reporting, medication error reporting, and medication recall administration.

  • Experience leading and mentoring managers responsible for core services.

  • Experience supervising & managing licensed pharmacy technicians, pharmacy coordinators/business analysts, and licensed clinical pharmacist specialists and program managers.

  • Comprehensive experience implementing and managing programs that require consultation, coordination, collaboration, recommendation, and monitoring of drug therapy initiatives, guidelines, protocols, and quality improvement projects by Providence employed physicians and pharmacists, as well as other physicians, pharmacists, and health care providers.

  • Expert experience in leadership and management of prescription drug benefits and medication aspects of medical benefit management.

  • Clinical and financial management experience utilizing multiple data sources that are necessary to document "return on investment" associated with implemented and planned projects and programs.

  • Experience with 5-Star metrics & measurement and NCQA accreditation.

  • E-prescribing, real-time benefit, and e-technology platform experience to include automated POS pharmacy claims administration and automated pharmacy prior authorization and formulary tools.

Preferred qualifications for this position include:

  • Specialty residency or fellowship

About Providence in Oregon.

As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work environments and unparalleled career opportunities. The Providence Experience begins each time our patients or their families have an encounter with a Providence team member and continues throughout their visit or stay. Whether you provide direct or indirect patient care, we want our patients to feel that they are in a welcoming place where they can be comfortable and free from anxiety. Our employees create the Providence Experience through simple, caring behaviors such as acknowledging and welcoming each visitor, introducing ourselves and Providence, addressing people by name, providing the duration of estimated wait times and updating frequently if timelines change, explaining situations in a way that puts patients at ease, carefully listening to their concerns, and always thanking people for trusting Providence for their healthcare needs. At Providence, our quality vision is simple,

"Providence will provide the best care and service to every person, every time."

Providence is consistently ranked among the top 100 companies to work for in Oregon. It is also home to two of our award-winning Magnet medical centers. Providence hospitals and clinics are located in numerous areas, ranging from the Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of Portland. If you want a vibrant lifestyle while working with a team highly committed to the art of healing, choose from our many options in Oregon.

We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit

https://www.providenceiscalling.jobs/rewards-benefits/

Our Mission

As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.

About Us

Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

Schedule: Full-time

Shift: Day

Job Category: Clinical Director/Executive

Location: Oregon-Beaverton

Other Location(s): Montana, Nevada, Washington, Oregon, Texas, Alaska

Req ID: 322745

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