VP, Pharmacy Management (Hybrid)

PURPOSE:

The Vice President will lead the development and implementation of a multi-faceted program to reduce pharmacy spending and the total cost of care, while improving clinical outcomes. This role will oversee the day-to-day policy and operations of Pharmacy team, including oversight of its PBM and other vendor relationships.

ESSENTIAL FUNCTIONS:

• The Vice President will lead the development and implementation of a multi-faceted program to reduce pharmacy spending and the total cost of care, while improving clinical outcomes. To date, these initiatives include comprehensive medication reviews, specialty pharmacy management, and formulary development. The Vice President will lead the evaluation of these programs to ensure they are implemented in the most effective way. The Vice President will ensure that these programs are well-integrated into CareFirst’s breadth of clinical programs and will ensure that CareFirst’s Sales and Marketing teams are educated to communicate the value of these programs.

• The Vice President will serve as CareFirst’s primary point of contact and relationship manager with its PBM vendor(s) and other strategic vendor partnerships to implement CareFirst’s Pharmacy programs and services. He/she will communicate CareFirst’s business strategies to vendors and ensure that vendors faithfully execute contract terms. He/she will lead the evaluation and selection of new vendor relationships and evaluate the performance of current vendors.

• The Vice President will oversee and manage all day-to-day operations of CareFirst’s pharmacy benefit management programs.. He/she will coordinate closely with CareFirst’s business leaders and clinical operations teams to ensure the appropriate execution of CareFirst’s pharmacy benefits services across multiple business lines. He/she will oversee the development of CareFirst’s formulary, managed through an external PBM(s).

• The Vice President will ensure the timely analysis and communication of trends of pharmacy expenditures, working closely with CareFirst’s actuaries and Data and Informatics teams. He/she will produce and monitor a dashboard of the most critical data elements and produce actionable insights for CareFirst’s Executive Leadership.

• Oversees the strategic and the day-to-day activities of the Department, including directing, coaching, and guiding associates to implement departmental, divisional, and organizational mission/goals. Recruits, retains and develops a high performing team. Evaluates performance of each team member, generates development plans and sets goals within the context of the corporate policies and procedures. Develops annual goals, and prepares, monitors, and analyzes variances of departmental budgets to control and appropriately allocate resources.

SUPERVISORY RESPONSIBILITY:
This position manages people .

QUALIFICATIONS:

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.

• The requirements listed below are representative of the knowledge, skill, and/or ability required.

• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education Level: Pharm.D

Experience: 10 years of experience in the healthcare industry, with focus on pharmacy benefit management with 5 years of progressively responsible management experience.

Preferred Qualifications:

• MBA
• Commercial, Medicaid and Medicare experience

Knowledge, Skills and Abilities (KSAs)

• Must have deep business acumen and fundamental understanding of the current issues and trends within the pharmacy marketplace with a focus on specialty pharmacy.
• Strong understanding of contemporary clinical, operational and regulatory pharmacy practices.
• Thorough understanding of prescription benefit management programs and practices, contracting, products/services, cost structures, pricing and business practices.
• Experience in (or working knowledge of) formulary management.
• Demonstrated success in pharmacy program development, monitoring and quality improvement.
• Experience in (or working knowledge of) specialty pharmaceuticals.
• Proven capabilities in strategic planning and large-scale project management including developing, planning, executing, and measuring program results.
• Demonstrated ability to develop innovative solutions through the application of advanced problem-solving skills and skilled in garnering cross-functional support as required.
• Strong negotiation skills and analytical skills.
• Outstanding project and resource management skills.
• Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Department

Department:

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.