Job Description

Job Title: AVP, Clinical Pharmacy Health Plan
Job ID: 49368652
Status: Full-Time
Regular/Temporary: Management
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: PHARMACY SRVCS
Location: 600 Grant St, Pittsburgh PA 15219

Description

Purpose:
Manages and coordinates the pharmacy services clinical programs. This includes the direct supervision of the clinical pharmacy staff by assisting the Sr Vice President of Pharmacy in identifying opportunities for clinical programs, supporting existing clinical services, establishing goals and objectives and evaluating staff performance and competency. Additionally included: P&T processes, formulary and utilization management, assisting with benefit configuration, retrospective clinical programs, pharmacy care management, Quality, regulatory compliance coordination and stakeholder facing activity. Analyze systems and resources to maximize their effectiveness; analyze and control the financial performance of the department, develop innovative models of care.

Responsibilities:
  • Develop staff, service and programs to support drug and disease related clinical staff education.Actively participate in professional organizations at the local, state and national levels to bring recognition to the Health Plan Manage the Pharmacy Residence programEffectively represent Pharmacy to the Sales, Account Management and Broker organizations including sales presentations, RFP, etc
  • Identify, develop and implement evidence-based, policy opportunities specifically around off-label use, understanding LCDs and NCDs, clinical trials, etc.Assist in the development of clinical programs to wrap around our owned pharmacy distribution programs.
  • Assist in the development, implementation, and ongoing evaluation of the Health Plan's pharmacy offerings.Develop and manage pharmacy initiatives that efficiently focus on quality, appropriate and cost-effective utilization and client, member and provider satisfaction. Including NCQA/HEDIS, MTM, Medicare STARS, etc.
  • Overall responsibility to identify Specialty Pharmacy Formulary and Utilization Management opportunitiesInterface with external partners, providers, clients, or customers, to ensure optimal clinical prescription benefit design, implementation, and processes.
  • Overall responsibility to identify Clinical Pharmacy programs including Formulary, Utilization Management, Care Management and DUR opportunitiesAssist with the development of a strategic plan for Specialty Pharmacy Management services.
  • Develop, implement, and manage a strategic plan for Clinical Pharmacy Management services. Establish a documented course of action, with alternatives, to accomplish short and long term goals.Oversee the Health Plans Pharmacy P&T processes
  • Participate in committees relevant to strategic issues impacting clinical pharmacy.Ensure the integration of systems and communication among personnel in various pharmacy entities including Falk, MUH, PUH, HC Pharmacy, Integrated Pharmacy Services, Affiliate Institutions and the School of PharmacyRecruit, support and develop an exemplary clinical and technical staff and ensure their continued competence through an annual assessment program.
  • Regularly review and analyze department reporting to ensure compliance with the business plan and Health Plan processes and strategy.Routinely monitor effectiveness and quality of clinical programs including savings versus disruption, pharmacist inter-rater reliability and processing quality.
  • Through data analysis, identify evidence based, best practice utilization opportunities within both the medical and pharmacy drug utilization translating these targets into effective UM strategies.Work in conjunction with the pharmacy economics division and Center for Value Based Pharmacy Initiatives to develop evidence based study opportunities to build our value proposition of innovative clinical pharmacy management.
  • Communicate a strong service management philosophy and develop programs and supports for the staff to follow this philosophy. Analyze resource utilization in order to ensure maximum efficiency and effectiveness of their use.Monitor, analyze and report on the financial performance of the department in order to ensure operation within budgeted and non- budged approved guidelines.Collaboratively assist in the management of the Health Plan pharmacy budget

Qualifications

  • Doctorate in Pharmacy (PharmD) or management equivalent with 5-10 years experience in a progressively more responsible managed care pharmacy setting
  • Analytical and management ability necessary to establish, prioritize and execute goals and objectives
  • Interpersonal skills necessary to establish and maintain an effective working relationship with medical staff, administration, and other management personnel, interact with peers in other organizations, communicate with vendors
  • Excellent verbal and written communication skills
  • Ability to function as a team member within the department, the division, the health plan, and the health system 


Licensure, Certifications, and Clearances:
  • Current licensure or licensure eligibility to practice pharmacy in the Commonwealth of PA
  • Pharmacist

UPMC is an Equal Opportunity Employer/Disability/Veteran

Salary Range: $0 / hour

Union Position: No

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