Pharmacy Director

·Works in the community to build and maintain strong relationships with key figures with an effort provide best in class heath care to the members

- DTM – focus areas, tracking results, program enhancements
- Pharmacy queue improvement
- Care Gaps
- Review PBM policies and procedures for compliance with applicable state requirements.

• Reviews clinical/financial recommendations and strategies provided by the clinical pharmacists in order to determine feasibility and appropriateness for client and ensure flawless implementation of these initiatives. Monitors each of the initiatives to measure results.

• Monitor CLIENT pharmacy trends; make recommendation for process, product and program improvement; plan, implement, and monitor changes.
• Support CLIENT medical management goals by being a point person for the implementation of all pharmacy related clinical program initiatives.
• Provide support and attend all pharmacy related meetings and committees sponsored by the health plans and represent CLIENT and participate on the plan’s P&T Committee.
• Keep abreast of industry trends and regulatory changes in the pharmacy industry and evaluate their effect on pharmacy contracts and services.
• Provide on-site education and training for CLIENT providers on applicable processes procedures.
• Develop strategies along with our PBM partners to improve HEDIS ratings and other quality measures
• Participate in onsite visits to hospital systems and selected physician group practices and pharmacies.
• Act as the main point of contact for physicians and plan staff who are experiencing problems with the pharmacy program (decisions, process, timeliness, etc.)
• Supports Fraud and Abuse program system oversight. Communicates any suspected fraud discovered by the contact center staff. Recommends course of action for providers where patterns appear outside of guidelines and generally accepted pharmacy standards
• Provide on-site consultation and education to nurses, case managers, and/or physicians.
• Coordinates with CLIENT Compliance team on key operational and medication management issues identified through plan oversight and monitoring of PBM
• Develop/Build relationships with the local behavioral health providers, Perform Care staff, and client with the goal of improving the delivery of health care programs.
• Create and support an environment which fosters teamwork, cooperation, respect and diversity.