Job Description
Responsible for establishing new and managing existing Kroger Prescription Plans (KPP) benefit programs by focusing on effective management of all pharmaceuticals including specialty products, developing and managing industry leading, highly managed clinical strategies and innovative programs to drive lower average drug spend for KPP clients. Support all formulary and clinical functions in accordance with established policies and practices. Demonstrate the company's core values of respect, honesty, integrity, diversity, inclusion and safety.
Responsibilities
- Develop and implement new clinical strategies and programs, provide ongoing oversight of clinical programs and their outcomes
- Meet with clients to discuss clinical trends, review relevant pharmacy data, and provide recommendations/supportive rationale for clinical management strategies
- Support growth of pharmacy products, assist in development of a robust clinical management playbook and training platform for sales initiatives and client management
- Gather information from various sources to make informed decisions, translate and decipher how current pharmacy/healthcare trends will affect our clinical strategies
- Act as a clinical and drug information subject matter expert on the account team
- Analyze and evaluate pharmacy data and develop reports, presentations, or recommendations to differentiate KPP clinical programs, improve healthcare outcomes, and control drug spend
- Collaborate with various work groups to provide quality of care, control cost, integrate activities, communicate issues, obtain approvals, resolve problems and maintain knowledge pertaining to new developments, requirements, and policies
- Perform prior authorization/appeal functions, including execution and criteria development
- Act as a preceptor for Advanced Pharmacy Practice Experiences (APPE) students
- Analyze impact reports to identify an appropriate course of action due to formulary/adjudication changes
- Provide clinical consultation, expertise and support services to KPP customers, including benefit designs, formulary analysis and drug spend analysis
- Remain current with pharmacy benefit manager (PBM) industry trends and maintain competitive knowledge
- Provide responses for requests for information for clinical services; develop proposals for prospective clients
- Assist with operations or projects, as required to maintain workflow, meet schedule and quality requirements, and support clinical development
- Travel to meet with clients, customers, prospects, and various enterprise business units
- Must be able to perform the essential job functions of this position with or without reasonable accommodation
Qualifications
Minimum
- Doctorate Degree Pharmacy, PharmD
- Any project management experience
- 3+ years of experience in analyzing healthcare data
- 5+ years of pharmacy experience working for a leading health plan, pharmacy chain, or PBM
- Pharmacist License
- Extensive knowledge of pharmacy programs and services, specialty medications, formulary development, valuation, and maintenance and contracting processes
- Ability to prioritize/multi-task while providing accurate/on-time results
- Ability to work both independently and as part of a team
- Exceptional clinical, business, and relationship-building skills and must possess the ability to apply sound clinical judgment to a variety of situations
- Excellent administrative, communication, and organizational skill with high attention to detail
- Ability to translate information into a manner appropriate for clinical and non-clinical audiences
Desired
- Any managed care experience
- Any PharmD experience within a clinical practice
