Director of Pharmacy

Company: Health Plan of San Joaquin
Position: Director, Pharmacy
Reports to: Chief Medical Officer
Location: French Camp, CA

Health Plan of San Joaquin has retained Morgan Consulting Resources, Inc. to conduct the search for their Director, Pharmacy position based in French Camp, California. This opening represents a tremendous opportunity to join the leading Medi-Cal managed care provider in San Joaquin and Stanislaus counties serving almost 350,000 members!

About the Organization:

  • Serving California’s Central Valley since 1996, Health Plan of San Joaquin (HPSJ) is a publicly sponsored, not-for-profit HMO with a contract with the California Department of Health Care Services (DHCS) to manage health care for Medi-Cal members.
  • HPSJ provides compassionate, high-quality care through their collaboration with hundreds of Primary Care Physicians, all area hospitals, thousands of specialists, and the majority of pharmacies within San Joaquin and Stanislaus counties.
  • HPSJ has among the highest enrollee plan selection rates (91%) of any California-based Medicaid plan.
  • HPSJ is one of only twelve California health plans with NCQA Accreditation for a managed care Medi-Cal program.
  • HPSJ was recognized by the National Commonwealth Fund in 2017 for the Health Plan’s influence in regional health improvements realized through collaboration and capacity building.
  • HPSJ was awarded both planning and implementation grants from the California Health Care Foundation to reduce opioid dependency – a collaborative effort with San Joaquin General Hospital and Community Medical Center.
  • HPSJ partnered with San Joaquin General Hospital to launch a community outpatient Palliative Care program providing integrated, patient and family centered care for patients facing life-threatening health conditions.
  • You can learn more about HPSJ by visiting their website at https://www.hpsj.com/.

About the Position:

Reporting to the Chief Medical Officer, the Director, Pharmacy is responsible for leading strategy and delivery across all areas of pharmacy operations including: development, implementation and ongoing evaluation of all pharmacy based care management programs; prior authorization; administration of pharmacy benefit by contracted PBM; directing the pharmacy residency program to include curriculum development and accreditation; chairing the Pharmacy and Therapeutics Committee; ensuring compliance with all regulatory requirements; budgeting; analytics and reporting. This position manages a team of ten including: a Clinical Pharmacy Manager, Pharmacists, Pharmacy Technicians, Intake Processor and Pharmacy Coordinator.

We are looking for a strategic and collaborative pharmacy leader with managed care experience (Medicaid/Medi-Cal is desirable) who can execute on best practices to elevate organizational performance to the next level. The successful candidate will operate with a high level of accountability and have the interpersonal skills needed to build and maintain strong relationships both internally and externally. Those best suited for this role will possess excellent analytical, budget and team building skills. The ability to qualify as Residency Program Director is required.

Overview

Under limited supervision, responsible for overseeing the implementation of strategic and operational objectives and plans to support quality and cost effective care, and corporate decision-making. Work is varied and highly complex, and requires a high degree of discretion and independent judgment.

Supervises

Pharmacy staff including:

  • Manager, Clinical Pharmacy; Pharmacists; Pharmacy Technicians; Pharmacy Residents and students; Pharmacy Coordinators.

Essential Functions

  • Oversees pharmacy prior authorization process: conducts clinical review of pharmacy prior authorizations; approves/denies or offers formulary or therapeutic alternatives according to HPSJ’s pharmacy criteria.
  • Promotes clinically appropriate prescribing practices, which conform to HPSJ as well as national practice guidelines.
  • Leads the identification, development s and implementation of clinically effective and cost-effective pharmacy management, including but not limited to appropriate use criteria of medications, step edits, PA criteria or quantity limits; monitors and takes action based on results.
  • Leads and or supports the identification, development and implementation of HPSJ’s pharmacy based care management initiatives: compiles and analyzes medical and pharmacy data; identifies related member populations; recommends and develops appropriate physician and member interventions; monitors and takes action on results.
  • Supervises quantitative and qualitative analyses/evaluation; collaborates with medical directors and others to identify opportunities for improving cost effectiveness and quality of care and services, and to monitor and evaluate performance and to evaluate outcomes of programs related to pharmacy programs and interventions.
  • Anticipates technology needs; oversees development and implementation; collaborates to improve or upgrade current technology solutions; manages vendor performance and relationships.
  • Oversees the implementation and administration of HPSJ’s pharmacy benefit by contracted PBM: monitors performance; identifies and resolves performance issues.
  • Develops and prepares effective decision support tools and models for accurate evaluation of performance and to assist in management decision-making.
  • Assists the Pharmacy and Therapeutics committee in the development, maintenance and evaluation of the HPSJ’s drug formulary, clinically effective and cost-effective pharmacy management strategies, including but not limited to appropriate use criteria, step edits or quantity limits, and fraud and abuse.
  • Develops and maintains a Drug Utilization Review Program to meet all the regulatory requirements.
  • Ensures consistent dashboard reporting, adhoc reports as needed and analytics to support both cost of care and quality initiatives.
  • Monitors the pharmaceutical trends and new technology proactively to assess the impact on HPSJ and its members.
  • Develops or oversees the development of pharmacy policies and procedures; ensures the development and implementation of appropriate companion procedures, guidelines and other documents.
  • Develops and manages department budget.
  • Promotes, maintains and ensures that direct reports promote and maintain an environment that supports HPSJ’s strategy, vision, mission and values.
  • Hires, develops, supervises and retains an adequate and competent staff.
  • Directs the pharmacy residency program including curriculum development, accreditation and program growth.
  • Demonstrates leadership within the pharmacy department or within the organization, through a documented record of improvement in and contributions to pharmacy practice.
  • Demonstrates ongoing professionalism and contribution to the profession.
  • Chairs the Pharmacy &Therapeutics Committee and participates actively in other UM/QM Committees.
  • Organization and leadership of a residency advisory committee that provides guidance for residency program conduct and related issues.
  • Oversight of the progression of residents within the program and documentation of completed requirements.
  • Implements use of criteria for appointment and reappointment of preceptors.
  • Evaluation, skills assessment and development of preceptors in the program.
  • Creating and implementing a preceptor development plan for the residency program.
  • Continuous residency program improvement in conjunction with the residency advisory committee and working with pharmacy administration.

Knowledge, Skills and Abilities

  • Expert knowledge of and ability to apply and facilitate the adoption of best practices.
  • In-depth knowledge of the business, economic, demographic and political trends and developments affecting managed care, Medi-Cal and/or Medicaid.
  • In-depth knowledge of Medicaid, Medi-Cal and/or Medicare benefits, reimbursement and payment structures.
  • Expert knowledge of the principles and practices of managed care as they relate to pharmacy.
  • In-depth knowledge of HEDIS and NCQA as they relate to pharmacy and analytics.
  • Advanced problem solving, financial modeling and analytical skills, with ability to analyze and resolve complex problems of broad scope, develop effective action plans and implement to successful conclusion.
  • Advanced leadership skills, including but not limited to the ability to support corporate objectives, establish direction, build alliances, and inspire and motivate others across the organization and externally.
  • Ability to create, execute and monitor relevant strategic business plans.
  • Demonstrated ability to articulate and support HPSJ’s vision, mission, values and strategy, integrate into management practices, and foster their manifestation among staff.
  • Strong management skills, including but not limited to the ability to supervise staff in a manner that maximizes employee performance and business results.
  • Strong collaboration skills, including but not limited to the ability to create and foster a collaborative work environment, and organize people and resources to solve problems and identify opportunities.
  • Strong interpersonal skills, including the ability to establish and maintain effective working relationships with individuals at all levels inside and outside of HPSJ.
  • Strong oral and written communication skills, including the ability to communicate professionally and persuasively to diverse individuals and groups inside and outside of HPSJ.
  • Advanced presentation skills, including but not limited to the ability to tailor presentations to a specific audience, be persuasive and identify key messages.
  • Strong skills in budget development and management.
  • Strong project management skills, including the ability to manage organizational-wide projects to successful conclusion.
  • In-depth knowledge of change management theory, with ability to anticipate and implement effectively.
  • Advanced Excel skills, including the ability to create complex formulas and templates.
  • Advanced skills in Word, Excel and Outlook, including the ability to develop spreadsheets, formulas, and create tables and graphs.
  • Ability to speak and be understood in English.
  • Ability to handle confidential information with appropriate discretion.

Qualifications

Required Education & Experience:

  • Doctor of Pharmacy from an accredited college or university.
  • At least seven years of experience in all aspects of pharmacy administration in managed care, including six years in a management/supervisory capacity.
  • Equivalent combination of education and experience.
  • One of the following to qualify to be Residency Program Director:
    • Completed ASHP accredited PGY1 residency followed by a minimum of three years of pharmacy practice experience.
    • Completed ASHP-accredited PGY1 and PGY2 residencies with one or more years of pharmacy practice experience.
    • Without completion of an ASHP-accredited residency, have five or more years of pharmacy practice experience.

Preferred:

  • Completion of managed care pharmacy or clinical residency.
  • Experience selecting and implementing pharmacy benefit management systems.
  • Medicaid managed care experience, especially Medi-Cal experience.

Required Licensure:

  • Unrestricted California State Board of Pharmacy license.

About French Camp:

French Camp, in California’s Central Valley, is a commutable distance from several locations in the Bay Area, Sacramento and surrounding areas. The community offers an excellent quality of life, affordable housing and easy access to a variety of outdoor activities, including Lake Tahoe and Yosemite National Park.

Contact Information

If you or someone you know has the qualifications we seek, I’d love to set up a time to talk. Thank you so much for your time.

Lynn Barboza, Executive Recruiter
Morgan Consulting Resources, Inc.
lynn@morganconsulting.com

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