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Under the direction of the Chief Pharmacy Officer, the Clinical Pharmacy Director is responsible for managing a team focused on developing and executing comprehensive clinical pharmaceutical strategies that focus on improving health outcomes and affordability while delivering an unparalleled consumer experience for members, accounts and providers. Responsibilities include developing clinical programs and partnering with internal and external partners on optimal use and management of pharmaceuticals across the pharmacy and medical benefits. This position requires strong business acumen and ability to navigate cross functional relationships at all levels of the organization.
Lead ongoing implementation and maintenance of clinically appropriate and cost-effective programs to help control the escalating costs of pharmaceuticals and utilization across all lines of business including but not limited to formulary and utilization management strategies, benefit coding, website updates, member and provider communications, and internal training
Develop clinical programs directed at providers, customers, and internal care/case management teams in support of drug driven strategies to lower total cost of care.
Evaluate programs after implementation to ensure corporate objectives are met and identify areas of simplification for consumers
Oversee clinical and analytical evaluation of medication pipeline, supporting clinical policy development and management strategies
Facilitate Pharmacy and Therapeutics committee review and new to market medication evaluation processes
Partner with key external pharmacy organizations and develop aligned infrastructure to help facilitate success of clinical programs
Collaborate within the organization to support quality initiatives and other related activities related to HEDIS and NCQA
Maintain all departmental policies and procedures related to drug management processes
Assist in ensuring pharmacy related processes are carried out in accordance with DOI, CMS, and other federal and state requirements and guidance, including executive orders, regulatory requirements, and administrative rules. ·
Develop and implement programs with internal departments, the PBM, and/or other vendors to improve the member and provider experiences, including efforts toward population health and quality initiatives
Make presentations to and develop training, reports, and other communications for internal associates, members, providers, and other stakeholders related to pharmacy management results and trends
Lead team of clinical pharmacists to execute strategic plan and hold individuals accountable for meeting deliverables and outcomes
Special projects as assigned
Qualifications: (Knowledge, skills and abilities)
Ability to effectively manage, motivate, coach and mentor clinical staff to foster accountability and ownership of projects and deliverables
Demonstrated ability to deliver results
Ability to shape and execute strategy
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
Strong leadership, relationship building and influencing skills
Strong organizational and time management skills, including ability to work independently and prioritize multiple projects and assignments
Demonstrated strength in analysis, identification of problems and issue resolution
Strong written/verbal communication skills including presentation skills
Strong proficiency in MS Outlook, Word, Excel, PowerPoint, Visio, and Access
Professional Registered MA Pharmacist. Must hold unrestricted, current, and valid license to practice Pharmacy in the state of Massachusetts
Post-graduate residency / fellowship program or equivalent pharmacy practice experience in health-system pharmacy practice, ambulatory, or managed care pharmacy services.
PharmD required. Graduate study in a business, public health, or health policy field will be favorably considered.
7-10 years’ experience in the healthcare industry with focus on pharmacy benefit management, provider strategies and/or health plan business model
Experience in a managed care setting, either from the provider, the payer, or the PBM side of the industry, is required.
Prior experience in drug policy analysis and drug formulary management highly preferred
Experience in direct supervision of technical support staff for clinical and/or service/operational programs is preferred.
Internal Number: R03595
About Blue Cross Blue Shield of MA
Voted as the highest in member satisfaction among Massachusetts commercial health plans by JD Power, Blue Cross Blue Shield of Massachusetts is a community-focused, tax-paying, not-for-profit health plan headquartered in Boston. We have been a market leader for over 80 years, and are consistently ranked among the nation's best health plans. Our daily efforts are dedicated to effectively serving our 2.8 million members, and consistently offering security, stability, and peace of mind to both our members and associates.
As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. We are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path. We take pride in our diverse, community-centric, wellness-focused culture and believe every member of our team deserves to enjoy a positive work-life balance.
Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association.
Blue Cross Blue Shield of Massachusetts complies with applicable federal civil rights laws... and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation or gender identity.