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CareFirst BlueCross BlueShield · 23 hours ago

Director, Pharmacy Services, Government Programs - (Hybrid)

Baltimore, MD

Full-time

Hybrid

Senior Level, Lead/Staff

$158K/yr - $293K/yr

8+ years exp

CareFirst BlueCross BlueShield is seeking a Director of Pharmacy Services for Government Programs to implement their pharmacy vision and strategic plan. This role involves overseeing pharmacy staff, managing government program operations, and ensuring compliance with health regulations while collaborating with various stakeholders.

Health CareNon ProfitService Industry

No H1B

Responsibilities

Provides oversight and support for the management of multi-faceted Pharmacy Services Government Programs to reduce pharmacy spend, total cost of care, and improve health outcomes. Supports programs from evaluation through implementation and value realization. Monitors and tracks program activity and performance and communicates outcomes to key stakeholders within the organization

Respond to the Maryland Department of Health (MDH), U.S. Centers for Medicare and Medicaid Services (CMS), and other federal and state agencies as directed by leadership. Assist in ensuring pharmacy related processes are carried out in accordance with MDH, CMS, and other federal and state requirements and guidance, including executive orders, regulatory requirements, and administrative rules. Prepare for annual submissions to and respond to other requests from MDH and CMS. Oversee the creation and maintenance of the website contents, member/provider/internal communications in accordance with NCQA, Medicare, and MDH requirements

Manages and directs staff, demonstrating effective performance management of team members and supports activities to maintain a high functioning team. Reviews staffing goals and expectations to ensure that each is consistent and adequate to meet department goals. Provides coaching and motivation to team members ensuring staff has appropriate tools and training. Plans and manages the departmental budget

Serves as a point of contact for CareFirsts PBM vendor and other strategic pharmacy vendor partnerships. Ensures vendors execute contract terms. Identifies and implements vendor programs based on CareFirsts needs such as quality initiatives, compliance, population health, and/or member/provider experience

Analyzes Medicare and Medicaid pharmacy and medical drug utilization data to identify trends and at-risk populations; recommend and develop appropriate interventions; monitors and takes actions on results. Identifies business process improvements that are aligned with and supportive of business goals and objectives. Contributes to the development of dashboards that monitor critical data elements and tracks results for Executive Leaders. Identifies actional insights based on data and helps to ensure successful implementation of clinical savings

Develops, provides, and oversees formal written and verbal presentations and other communications related to clinical government pharmacy programs. Able to effectively present pharmacy information to key internal and external stakeholders at an Executive Level

Qualification

Pharm.D in PharmacyLicensed PharmacistPharmacy benefit administrationMedicare Part D experienceMedicaid guidelines experienceFormulary developmentClinical program developmentMicrosoft OfficeCustomer serviceCollaborationCommunication skills