Pharmacy Operations Manager

Are you excited to step into a complex world that requires a blend of mind, heart and flexibility? We at CareOregon have been strengthening communities since 1994 by making health care work for everyone. As a nonprofit health plan largely focused on Oregon’s Medicaid population, we find fulfillment in supporting the underserved.

General Statement of Duties

This position is responsible for managing clinical and non-clinical pharmacy benefits administration teams, formulary management and resources. Areas of oversight include medication utilization management, operational functions of pharmacy benefits administration, such as pharmacy benefit customer service, medication prior authorizations and appeals administration and vendor(s) oversight on delegated functions in these areas. This includes the development and implementation of program standards and procedures, monitoring program impact, and ensuring effectiveness and integrity. This position works closely with pharmacy management, staff and other managers across the organization to ensure collaboration, integration and support of organizational activities and goals.

Essential Position Functions

Technical/Operational Management

Oversee the operational and clinical functions of multiple teams. Work collaboratively with department leaders to oversee program standards and procedures and to monitor program impact and effectiveness on the health, experience, and cost of care for the membership.
Ensure policies and procedures meet CareOregon/Division of Medical Assistance Program (DMAP) contracting requirements and the Centers for Medicare and Medicaid (CMS) requirements.
Ensure program compliance with DMAP, CMS, and other relevant regulatory bodies that oversee health plan operations.
Act as a technical and operational resource to program supervisors and assigned staff.
Ensure integration of work between program functional areas; manage changes across teams and communications within CareOregon and between partners, providers and members.
Ensure Pharmacy Benefits customer contact center quality, service, efficiency and performance are effectively monitored, reported and positioned for success.
Work collaboratively with pharmacy teams and member experience/engagement teams for innovative solutions improving medication experience.
Ensures appropriate operational productivity, engagement, and quality metrics are established and met.
Ensure unit work is performed in coordination with other relevant CareOregon departments; service as a liaison and collaborator with multiple teams including member/provider customer service, claims, appeals and grievances, information systems, and others.
Oversee the use of an evidence-based process to perform new drug reviews, and to develop formulary recommendations and drug use criteria for the Pharmacy & Therapeutics (P&T) Committee.
Oversee the use of an evidence-based process to conduct medication utilization reviews to ensure safe and cost-effective utilization management meeting financial targets.
Work collaboratively with other CareOregon departments on medication process improvement projects and inter-departmental work teams.
Provide oversight of the delegated services of the CareOregon Pharmacy Benefits Manager (PBM) and/or other vendor(s) to ensure quality performance and compliance with regulatory and contractual requirements.

Program Development, Improvement, and Evaluation

Assist in regularly developing programmatic guidelines, and ensure these guidelines are followed.
Identify opportunities for improvement and participate in their development and implementation, including process improvement initiatives.
Develop, utilize and regularly monitor measures/metrics to improve the program’s effectiveness and efficiency of work processes.
Create a unit environment that encourages professionalism and teamwork and uses progressive problem solving to meet expectations.

Management and Leadership
Train, supervise and evaluate performance of assigned staff.
Provide staff with the training, mentoring and resources necessary to carry out their work.
Ensure adherence to department and organizational standards, policies and procedures.
Ensure performance goals, expectations and standards are clearly understood by supervised staff.
Evaluate employees’ performance on an ongoing basis and take appropriate corrective action if needed.
Perform human resource functions in collaboration with Human Resources.

Essential Department and Organizational Functions
Propose and implement process improvements.
Meet workload deadlines for completion of daily, weekly and month-end reporting.
Maintain agreed upon work schedule.
Demonstrate cooperation and teamwork.
Provide cross-training on specific job responsibilities.
Meet identified business goals that contribute to departmental goals.
Perform other duties as needed.

Knowledge, Skills and Abilities Required
Ability to critically evaluate clinical pharmaceutical and medical literature
Ability to apply principles of evidence-based medicine
Comprehensive, clinical pharmaceutical knowledge
Knowledge of the principles of managed care, pharmacy benefit management, pharmaceutical reimbursement, and pharmaceutical utilization
Knowledge of Oregon Health Plan (OHP) or other Medicaid benefits and regulatory requirements
Knowledge of Medicare Part D benefits and regulatory requirements
Knowledge of principles of organizational change and ability to act as a change agent
High degree of initiative and motivation
Ability to work independently
Excellent organizational, project management, and time-management skills
Excellent reading, oral and written communication skills
Excellent problem solving and decision-making skills
Excellent interpersonal skills
Ability to develop and implement processes and procedures
Ability to effectively collaborate with the department’s leadership and staff, and other stakeholders/customers
Ability to work well under pressure in a complex and rapidly changing environment
Ability to provide effective leadership and supervision to groups of people including mentoring staff growth
Ability to oversee services involving substantial costs
Ability to negotiate, problem-solve, and consensus-build
Ability to work with diverse individuals and groups
Ability to manage multiple tasks and remain flexible in a dynamic working environment
Proficient in computer and database skills, including MS Windows, Word, Excel, Power Point, and Outlook

Physical Skills and Abilities Required
Lifting/Carrying up to 0 Pounds

Pushing/Pulling up to 0 Pounds

Pinching/Retrieving Small Objects

Crouching/Crawling

Reaching Above Shoulders

Climbing Stairs

Repetitive Finger/Wrist/Elbow/

Shoulder/Neck Movement

0 hours/day

0 hours/day

0 hours/day

0 hours/day

0 hours/day

0 hours/day

3-6 hours/day

Standing

Walking

Sitting

Bending

Seeing

Reading

Hearing

Speaking Clearly

0 hours/day

0 hours/day

0 hours/day

0 hours/day

More than 6 hours/day

More than 6 hours/day

More than 6 hours/day

3-6 hours/day

Cognitive and Other Skills and Abilities Required

Ability to focus on and comprehend information, learn new skills and abilities, assess a situation and seek or determine appropriate resolution, accept managerial direction and feedback, and tolerate and manage stress.

Education and/or Experience

Required:

Graduate from an accredited College of Pharmacy
Advanced degree in pharmacy practice (Pharm.D, M.S., or Ph. D)
A current unrestricted Pharmacy license
Minimum five years practical experience as a clinical pharmacist in formulary management or ambulatory care or other clinical setting
Minimum two years of leadership and/or supervisory experience
Preferred:

Managed care experience

Working Conditions

Environment: This position’s primary responsibilities typically take place in the following environment(s) (check all that apply on a regular basis):
☒ Inside/office ☐ Clinics/health facilities ☐ Member homes

☐ Other_________________________________________

Travel: This position may include occasional required or optional travel outside of the workplace, in which the employee’s personal vehicle, local transit, or other means of transportation may be used.
Equipment: General office equipment
Hazards: n/a
Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment

Veterans are strongly encouraged to apply.

Equal opportunity employer. This company considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

Position Description »