Pharmacy Product Director - Medicare DSNP

Pharmacy Program Manager

Company : Highmark Inc.

Job Summary : This job supports the VP, Pharmacy in managing the overall Pharmacy program administration associated with the respective client portfolio as well as its P&L and contract compliance. Responsibilities include leading initiatives regarding the specific business line expense trends, cost efficiency strategies, contractual or programmatic changes, quality-of-care outcomes, customer service and other specific product related requirements. The incumbent also contributes to and executes on the strategic plan for his or her product. The incumbent requires a thorough understanding of all aspects of the pharmacy product.

Essential Responsibilities :

• Create and maintain strategic partnerships with customers through the development and implementation of product business plans that result in long term retention of profitable relationships.
• Analyze key performance indicator reports, identify negative trend and opportunities for improvement, facilitate internal collaboration to develop and implement solutions, and continuously monitor results to assess the value of implemented initiatives.
• Lead product based pharmacy trend management discussions with internal partners including senior executives.
• Support contractual pharmacy-based risk-sharing arrangements, and provide industry and product specific Pharmacy insight for capitated rate negotiations and internal financial forecasting.
• Provide clinical expertise, and serve as an influential member of internal clinical and value-based evaluation committees that drive formulary and utilization management functions.
• Participate in product specific Pharmacy and Therapeutics Committees and Drug Utilization Review (DUR) Committees as necessary or contractually required.
• Participate in product specific government meetings as necessary.
• Coordinate implementation of clinical programs and operational requirements as necessary.
• Support product specific business retention and business development activities as necessary.
• Ensure that all contractual obligations including service level agreement (SLA) targets are achieved.
• Ensure that all related regulatory requirements are understood and followed.
• Other duties as assigned or requested.

Qualifications :

Skills :

Scope of Responsibility :

Does this role supervise / manage other employees? No

Is Travel Required? Yes

Disclaimer : The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

Pay Range : Minimum $92,300.00 Pay Range Maximum : $172,500.00

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.