VP, Pharmacy Utilization Management

Summary: This position will coordinate and oversee all pharmacy plans for the organization. This position is responsible for managing vendor relationships, conducting pharmacy benefit analysis and providing consultation to the Medicare Part D and commercial drug utilization management programs. Incumbent is responsible for the leadership, oversight, and development of pharmacy utilization and formulary programs. Essential Duties and Responsibilities include the following. Other duties may be assigned. • Manages all facets of pharmaceutical contracting and pricing • Leads and/ or participates in new program implementation, process establishment, and maintenance in collaboration with vendors • Develops appropriate strategic plans to manage pharmacy costs • Creation of annual budget with respect to reduced costs and operational needs. • Oversight of pharmacy benefits manager (PBM) contract, amendments, specialty agreements, including monitoring of contract compliance and auditing of network rates to confirm reimbursement rates are applied accurately and correctly • Ensures contract compliance and performs analysis regarding pharmacy claims and purchasing data to identify contracting opportunities. Identify and make recommendations when opportunities for improvement in operational processes and program structures are available. • Establishment of all plan formularies. Directs team through high complex research and analysis related to prescription drugs and their applications in support of formulary development and the prior authorization program. • Monitors current and emerging trends in formulary utilization management strategies. • Establishes scope of services and develop annual implementation plans which contribute to organizational strategic objectives. • Designs and implements projects, programs, and initiatives to improve program processes to ensure compliance with contractual and regulatory requirements. • Identifies and maintains compliance standards for URAC, NCQA, as well as state and federal agencies. • Communicates with staff and promote staff ownership in problem solving and participation in operational decision-making. • Serves on interdisciplinary committees to provide leadership in identifying problematic prescription patterns, drug utilization review, prior authorization, and quality assurance programs • Communicate, collaborate and cooperate with internal and external stakeholders. • Adheres to all Compliance/Program Integrity requirements. • Complies with HIPAA Regulations. • Other duties as assigned. Candidate Qualifications Education:Bachelor of Science in Pharmacy or Doctor of Pharmacy degree preferred Licenses/Certifications:Current, unrestricted pharmacist license or licensure by the Texas State Board of Pharmacy within one (1) year of employment Experience / Knowledge / Skills • Minimum of five (5 )years experience in pharmacy network operations, contracting, pricing and pharmacy benefit management • Knowledgeable and compliant with all relevant laws, rules regulations and accreditation standards and requirement • Experience with health care contracting, pharmacy benefit managers, Medicare/Medicaid plans, Healthcare Exchanges, benefit design and cost containment strategies and previous staff management experience • Strong research, analytical and problem-solving capabilities • Ability to solve problems, establish trust and credibility and deal effectively with change • Proficient in word processing, spreadsheets and databases. • Excellent verbal and written communication skills. Job Type: Full-time Pay: $95,160.00 - $150,000.00 per year Benefits: • 401(k) • 401(k) matching • Dental insurance • Employee assistance program • Employee discount • Flexible spending account • Health insurance • Health savings account • Life insurance • Paid time off • Vision insurance Schedule: • 8 hour shift Ability to Commute: • Houston, TX 77079 (Required) Ability to Relocate: • Houston, TX 77079: Relocate before starting work (Required) Work Location: In person