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Company

Mount Sinai Health System · 10 hours ago

Pharmacy Benefits Program Director; HSO Pharmacy; Mount Sinai Health System

United States

Full-time

Remote

Director/Executive

$154K/yr - $231K/yr

6+ years exp

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Responsibilities

Work with internal stakeholders to maintain the commercial formulary change process, evaluating pharmacy and medical drug strategy opportunities and formulary product enhancements to drive pharmacy affordability to Mount Sinai Health System.

Responsible for the development of complex utilization management strategies and drug utilization review programs to enhance formulary strategies and improve clinical outcomes in alignment with the clinical determination of the Pharmacy and Therapeutics Committee.

Ensures the clinical integrity of the Health Plan pharmacy offering.

Partners with Health Plan Supply Chain to evaluate and deploy available service solutions that meet Health Plan clinical and affordability goals.

Develops differentiated prescription drug benefit affordability capabilities that meet the unique needs of the buying groups and funding types within the Health Plan book of business.

Responsible for ensuring downstream implementation processes are efficient and support the continuous development of business strategies.

Ensure regulatory compliance by reviewing new state mandates and updating internal processes to support adherence.

Provides clinical and contextual insights to partners within the Health Plan finance, underwriting, and risk-bearing products to ensure that emerging therapeutics and revisions to the US drug supply are accurately reflected in financial projections (trend, underwriting, and pricing).

Partner with the Health Plan Medical organization to support discussions with professional societies about complex and/or controversial formulary changes where engagement with external organizations is needed.

Creates a sense of purpose/meaning for the team that aligns with Mount Sinai values and mission.

Supports and promotes appropriate team alignment and process improvement work.

Provides coaching and development to teams, in particular, direct reports for succession planning and overall career growth.

Participate in meetings and presentations to review benefits management performance.

Act as pharmacy representation for renewals involving consultants.

Collaborate with Mount Sinai Health System Payer Contracting leadership with contracting proposals and growing existing relationships.

Gather and share relevant competitive intelligence to promote clinical programs and savings strategies.

Remain abreast of clinical pharmacy practice guidelines, including drug pipelines, bio-similars, gene therapies, and patent expirations, etc.

Facilitate meetings with PBM to resolve customer service issues and act as the escalated issue contact for pharmacy matters.

Support detailed ad hoc analysis of pharmacy claims utilization in order to provide clients with consultation and manage follow up questions as they arise.

Educate and consistently advance the knowledge of pharmacy within Mount Sinai Health System and champion the understanding of clinical integration points across benefits.

Fosters an effective work environment and ensures employees receive appropriate communication, recognition and development.

Any other tasks as assigned by management.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Registered PharmacistClinical Program DevelopmentPharmacy Benefit ManagementStrategic PlanningOperational Understanding of PBMFinancial Strategies of PBMUnderstanding PBM SpaceProject ManagementClient ManagementMicrosoft ProgramsOrganizational AgilityFinancial AcumenCustomer FocusNegotiating Skills

Required

Registered Pharmacist required with active licensure in a US state or territory; advanced degree a plus.

Previous experience in developing clinical programs related to Formulary and Utilization management required.

Minimum of 6 years experience in the healthcare industry, with focus on Pharmacy Health Plan or Pharmacy Benefit Management.

Proven capabilities in strategic planning and large-scale project management.

Demonstrated ability to think/act strategically from a program value perspective and influence key leaders and matrix partners.

Demonstrated ability to work in a highly matrixed environment.

Strong communication and facilitation skills with all levels of the organization, including ability to resolve issues and build consensus among groups of diverse internal/external stakeholders.

Experience with consultative client management methodologies.

A self motivated individual displaying ownership, accountability, and responsibility.

Ability to work through organizational processes needed to support clients.

Operational understanding and competence with PBM business models.

Understanding of the financial and pricing strategies of PBM's.

Technical skills using all Microsoft programs