|The director, pharmacy managed care, will set the strategy on pharmacy sales and service and oversee all aspects of managed care processes and relationships. This leader is responsible for sales growth, expense control (e.g., write-offs and audits), gross profit enhancement, asset management and reporting as needed/required pertaining to third party prescription programs which account for more than 85% of the total pharmacy business. This pharmacy operations expert will develop and coordinate third-party and retail pharmacy interests with various corporate departments and suggest ways to streamline and improve.|
|Primary Responsibilities & Accountabilities|
- Establish and maintain working relationships with executive level and middle management level insurance program administrators.
- Evaluate, negotiate and manage performance of third-party contracts as well as provide strategies for maximizing revenues from these plans.
- Monitor contract consistency and compliance, which includes market share, profitability, MAC, reimbursement, ROI analysis and alternative revenue programs, and take action with vendors who do not conform to contract terms.
- Review audit trends, respond to third-party audits and develop store processes, training and communication for field staff to minimize recoupment by third party plans and state agencies.
- Design, direct, monitor and report on AWP pricing resubmission programs to maximize gross profit results.
- Analyze, collaborate and define tactics with the risk management department regarding the workers� compensation program, identifying ways to improve compliance, reduce expenses and improve profitability.
- Provide guidance and feedback to total rewards for the team member pharmacy benefit plan as it relates to retail operations; utilize pharmacy operations expertise on third party plans to analyze opportunities and develop programs to improve team member therapeutic outcomes and reduce plan administrative costs.
- Interface with accounting department to identify issues with pharmacy accounts receivable (PAR) and make suggestions to enhance the program in order to manage and reduce third party write-offs, give direction in managing reimbursement/collection issues and provide strategy in the development of advanced third-party reporting to identify opportunities for increased collection revenue rates.
- Provide direction for store enrollment, licensing/permits and adjudication processes for all private insurance and governmental prescription plans.
- Give direction for review of third-party drug records and plan maintenance and provide oversight to ensure plans loaded into the pharmacy management system are legally compliant and maximize profit; identify and provide solutions on any shortcomings.
- Establish and maintain key pharmacy contact status with representatives of Medicare, Medicaid, private payers, industry groups (FMI, NCPDP, NACDS, etc.) and significant state organizations (Florida Retail Federation, etc.).
- Develop and review policies and procedures to ensure they encompass third party contract requirements making recommendations to the legal department where appropriate.
- Perform other job-related duties as assigned.
- Bachelor�s degree in business administration or related field and ten (10) years progressive management experience, or an equivalent combination of education and experience.
- Possess valid driver�s license with a satisfactory driving record.
- Compliance with all company policies and procedures.
- Ability to read, write and speak English proficiently.
- Ability to understand and follow English instructions.
- Authorization to work in the United States or the ability to obtain the same.
- Successful completion of pre-employment drug testing and background check.
- Master�s degree in business administration or related field; or equivalent experience.
- Ability to manage and direct multiple complex projects simultaneously to drive solutions that meet or surpass business expectations and deliver project milestones on-time and within budget.
- Lives the Valuesby embracing the essence of the company demonstrating a commitment to the company�s goal and values.
- Unifies and motivates team through praise and recognition of success with immediate feedback to build an environment of trust.
- Business-drivenshowing passion for the business, delivering results consistently.
- Customer-orientatedby passionately demonstrating that the customer comes first� always by putting the customer�s needs above all else.
- People Passionthrough consistently treating others with respect and dignity.
|Knowledge, Skills, Abilities|
- Demonstrated strong PC skills including proficiency with the primary Microsoft Office applications.
- Demonstrated ability to apply management principles and techniques to direct, educate and motivate employees.
- Excellent communication and interpersonal skills to effectively convey complex and detailed information to a diverse population.
- Exceptional problem resolution and process improvement skills.
- Superior analytical, organizational, decision-making and project management skills.
- Ability to exercise strong judgment in analyzing, evaluating and solving problems of a difficult procedural, organizational, administrative or technical nature.
- Fully versed in administrative and budgetary management functions.
- Ability to maintain the highest level confidentiality.
- Intense focus on detail and accuracy of work.
- Ability to travel up to 25% of the time, including overnight.