What You’ll Be Doing:
Health Plan Pharmacy Leadership
- Function as the delegated Director of Pharmacy for client health plans including Medicaid and Medicare (including SNP plans)
- Create and enhance State-specific programs such as lock-in, provider outreach, and quantify the value of those initiatives
- Collaboratively participate in development & maintenance of the Drug Formulary(s) with Evolent PBM Operations and our key business partners.
- Oversee (and participate as needed) in client-specific communications process to ensure effective change management.
- Establish and maintain effective, collaborative working relationships with Evolent PBM Operations, our key business partners, the Market Leadership, and contracted vendors
- Be the main account management point of contact between the Client and Evolent Health teams
- Provide pharmacy subject matter expertise during the start-phase (e.g., Ongoing Medicaid operations, interactions with the State as well as Medicare Advantage application & submission process, state-regulatory application process for Commercial health plans) of client health plan operations
- Ensure management of pharmacy department activity with emphasis on the quality of care, accessibility, financial impact and regulatory compliance.
- Develop initiatives to identify, track and monitor pharmacy utilization and opportunities for cost savings, trend management, and/or quality improvement.
- As a member of the pharmacy services leadership, cross collaborate with PBM Operations and Clinical Product Development to build and lead a highly effective, integrated pharmacy services platform
- Provide joint oversight for pharmacy analytics and modeling assure best in class trend management, clinical outcome achievement, and client service support
- Contribute to the design, execution and leadership of a comprehensive specialty pharmacy strategy
- Other duties as assigned.
The Experience You’ll Need (Required):
- Pharmacy degree; either BS Pharmacy or Pharm. D.
- 5-10 years of Medicaid experience
- 3+ years of PBM account management experience
- Pharmacy benefit & pharmacy health plan operations experience including area such as health plan pharmacy leadership, clinical utilization management, and/or benefit consulting
- Active Pharmacy License
Finishing Touches (Preferred):
- Advanced “business” degree (e.g., MBA, MHA)
- +2 years health plan pharmacy director or PBM clinical operations leadership
- +2 years Medicare Advantage health plan pharmacy experience
- “Start-up” experience with Medicare Advantage, Medicaid and/or Commercial plans