Apply on line at http://www.alohacare.org/Careers/Default.aspx
AlohaCare is a local, non-profit health plan serving the Medicaid and Medicare dual eligible population. We provide comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers. Our mission is to serve individuals and communities in the true spirit of aloha by ensuring and advocating access to quality health care for all. This is accomplished with emphasis on prevention and primary care through community health centers that founded us and continue to guide us as well as with others that share our commitment. As Hawaii’s third-largest health plan, AlohaCare offers comprehensive prevention, primary and specialty care coverage in order to successfully build a healthy Hawaii.
AlohaCare employees share a passion for helping Hawaii’s most underserved communities. This passion for helping and caring for others is internalized and applied to our employees through a supportive and positive work environment, healthy work/life balance, continuous communication and a generous benefits package.
AlohaCare’s leadership empowers and engages its employees through frequent diversity, recognition, community, and educational events and programs. AlohaCare has a strong commitment to support Hawaii’s families and reinforces a healthy work/home balance for its employees. Because AlohaCare values honesty, respect and trust with both our internal and external customers, we encourage open-door, two-way communication through daily interactions, employee events and quarterly all-staff meetings. AlohaCare’s comprehensive benefits package includes low cost medical, dental, drug and vision insurance, PTO program, 401k employer contribution, referral bonus and pretax transportation and parking program.
These employee-focused efforts contribute to a friendly, team-oriented culture which is positively reflected into the communities we serve.
The primary responsibility of this position is to assure that the Pharmacy Department is aligned with the AlohaCare’s mission, values, goals, and strategy through planning, operational management, and financial accountability. The Director strives toward the quality and safety of member care, collaborating with other departments and programs in ensuring member access to medically necessary medications, reducing polypharmacy, preventing adverse drug interactions, and improving drug compliance. The Director oversees utilization management, contractual and regulatory compliance, Pharmacy Benefit Manager delegation, and external relationships with providers, public agencies, and others. The Director is a leader in executing AlohaCare’s Care Model that is both member-centric and population health focused.
Primary Duties and Responsibilities:
• Develops departmental strategic plans, goals and objectives that are consistent with the organizational wide strategic plan
• Collaborates with health services teams to integrate pharmacy benefits into overall AlohaCare Care Model.
• Is responsible for oversight of and liaison with AlohaCare’s Pharmacy Benefit Manager (PBM), including all delegated responsibilities such as Medicare formulary management, MTM, specialty pharmacy, network contracting, pricing, and claims payment.
• Manages AlohaCare responsibilities including MedQUEST formulary management, prior authorization, utilization management, pharmacy provider relations, contractual and regulatory compliance, 340B program, physician administered drugs, DUR, CMRs, and overall cost management.
• Directs pharmacy utilization management, involving over-and-under utilization, prior authorization, web-based tools, cross departmental work flows, timely training, policies & procedures, drug utilization reviews, and monitoring for medication regimens that indicate members at risk
• Is responsible for the department budgeting, financial forecasting, Medical Loss Ratio (MLR) initiatives, variance monitoring and corrections, and financial data analyses, as well as fosters a collaborative relationship with the Finance Department
• Designs and administrates a system of coverage criteria, based on PBM administration, national clinical practice guidelines or standards, department policies-and-procedures, evidence-based medicine, and local standard-of-care
• Guides the Pharmacy & Therapeutics Committee, encouraging active committee engagement and striving toward appropriate medication utilization, member safety, and provider satisfaction and making the Committee relevant to the AlohaCare’s response to a rapidly changing pharmaceutical space
• Represents and/or markets AlohaCare in all communications with external parties such as retail pharmacies, prescribers, members, and public agencies, ensuring the proper dissemination of all educational and informational
• Leads and ensures the implementation of pharmacy-related NCQA standards for accreditation
• Develops and administers a pharmacy information system, involving department dashboard and key performance indicators, PBM reports, systems for claims, care management, and risk stratification and leading to actionable analytics
• Responds to CMS or State Medicaid requests related to contractual and regulatory requirements, compliance audits, data verification, special reports, and inquiries specific to AlohaCare with the intention to avoid correction action plans and reputational risks
• Manages the Clinical Pharmacy Supervisor, Pharmacy Operations Supervisor, and their related staff
• Identifies opportunity for business development in partnership with other stakeholders
• Oversees the department’s human resources in terms of staffing, hiring/termination, productivity, efficiency, compensation, job expectations, performance, attendance, counseling, training, and staff development
• Participates actively in AlohaCare’s Fraud, Waste, and Abuse Program
• Responsible to maintain AlohaCare’s confidential information in accordance with AlohaCare policies, and state and federal laws, rules and regulations regarding confidentiality. Employees have access to AlohaCare data based on the data classification assigned to this job title
• 5+ years’ experience in pharmacy operations, including Medicare and Medicaid
• 5+ years’ experience in Managed Care (PBM or MCO)
• 5+ years’ experience in management, including managing supervisors or multiple teams
• Doctorate degree in Pharmacy
• Licensed in the State of Hawaii as a registered pharmacist
• Must have strong communication and team building skills
• Must have organizational skills and an eye for detail
• Proficient in Microsoft (MS) Word, Excel, Outlook, and PowerPoint
• Basic understanding and use of other clinical IT applications (e.g. formulary management, prior authorization, care management, etc.)
• Hawaii Medicaid managed care expertise either working directly for health plan or subcontracted PBM
• Prior pharmacy P&L/cost containment experience
Mental, Physical and Environmental Demands:
• Inter-island travel as needed to meet with contracted pharmacies and occasional travel to US Mainland for professional conferences
• Sedentary Work: Exerting up to 20 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time.
• Inside working conditions
• No environmental hazards
• Requires operation of general office equipment to include PC
AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veterans status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.Position Description »