Manager of Pharmacy - Government Programs

  • Premera Blue Cross
  • Mountlake Terrace, WA, USA
  • Feb 14, 2020
Full time Government

Job Description

Join Our Team: Do Meaningful Work and Improve People's Lives

Our purpose, to improve customers' lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.

To better serve our customers, we're creating a culture that promotes employee growth, collaborative innovation, and inspired leadership. We are committed to creating an environment where employees can do their best work and where best-in-class talent comes, stays, and thrives!

As the Manager of Pharmacy- Government Programs, you will develop and implement the pharmacy Government Program at Premera. In this role, you will communicate with both internal and external stakeholders regarding the program, and manage the Government Programs (Medicare Part D and Individual Healthcare Exchange Products) pharmacy product, ensuring all Centers for Medicare and Medicaid Services (CMS) and other state and federal regulatory requirements are followed. This position will support Premera's Government Program's financial and clinical goals, focused on pharmacy benefits and solutions.

What you will do:
  • Develop and execute the short term and long-term pharmacy strategic direction of Premera's Government Program; make recommendations, and execute on corporate Pharmacy initiatives impacting government programs lines of business.
  • Provide oversight of the Medicare Part D and Individual exchange products including being the primary Pharmacy contact with regulatory staff at the Centers for Medicare and Medicaid Services (CMS) or other regulatory bodies for operational issues and audits.
  • Work across all of the functional areas of Government Programs and contributing components, with shared responsibility for the overall Profit and Loss (P&L) for the Government Programs division.
  • Collaborate and coordinate with internal and external stakeholders including:
  • Support Medicare Part D Stars strategy or other regulatory measurement systems.
  • Develop strategy and ownership of PBM contracts including contract management, market price checks, audits and management of vendor relationship.
  • Provide oversight and manage all CMS or government audits in coordination with the Compliance Department.
  • Develop, implement, and manage clinical drug utilization strategies and provide Pharmacy business support to key internal and external stakeholders. This includes Part B drugs under pharmacy and medical claims.
  • Provide clinical and business support to internal government programs stakeholders including Pharmacy reporting and Sales, broker, or other market training.
  • Produce and analyze pharmacy cost trends, clinical and managed care presentations and Pharmacy communication materials.
  • Support medical management and clinical initiatives. Oversee Medicare Medication Therapy Management (MTM) program including program submission, attestation and oversight.
  • Hire, develop, and grow an effective team.
What you bring:
  • Pharmacist degree Active WA State Pharmacist license with six years of experience in clinical program development/management in a managed care setting.
  • Six years of experience in clinical program development/ management
  • Two years of experience with Medicare Part D and Government programs
  • Experience in a managed care pharmacy and/or project management is preferred.
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What we offer
  • Medical, vision and dental coverage
  • Life and disability insurance
  • Retirement programs (401K employer match and pension plan)
  • Wellness incentives, onsite services, a discount program and more
  • Tuition assistance for undergraduate and graduate degrees
  • Generous Paid Time Off to reenergize
  • Free parking
Equal employment opportunity/affirmative action:

Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.

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