Summa Health
Director, Pharmacy
Summa Health
– Akron, Ohio (Hybrid)
Employment type : Full Time, 40 Hours per week
Salary range : $80.17/hr – $120.26/hr (base salary, exclusive of bonuses)
Summary Provides Clinical Pharmacological leadership to the health plan, membership and provider network. Provides oversight for pharmacy and therapeutic issues, and ensures compliance with pertinent government regulations and standards.
Educational Requirement Advanced Degree or may substitute with 6 years of like experience.
Required Experience 5+ years performing same or similar responsibilities. Relevant experience includes working in Pharmacy Benefit Management either in a Health Insuring Corporation or other managed care environment and experience working with Medicare Part D. Minimum 5 years direct supervisory experience also required.
Required Licenses & Certificates Registered Pharmacist in State of Ohio. Valid driver license.
Software and Data Entry Requirement None required.
Essential Functions and Responsibilities
Reviews, monitors and recommends changes to prescription programs and formulary including limitations, pre‑authorizations, exceptions and non‑covered items. Oversees development and administration of Medicare Part D formulary.
Oversees selection, implementation, and performance of the Pharmacy Benefit Manager (PBM).
Assures regulatory compliance of the Pharmacy Department. Provides guidance to staff on operational and regulatory issues including compliance with CMS (Medicare MA and Part D), NCQA, Fraud Waste & Abuse, and ODI guidelines.
Develops and analyzes drug utilization reports, and makes recommendations to Senior Management for interventions.
Oversees Contracting Strategies as related to Pharmacy and Therapeutic issues. Manages Pharmacy & Therapeutics Committee including development of agendas and meeting materials. Reviews all committee actions and recommendations with Clinical Pharmacist and Chief Medical Director.
Serves as resource to HSM staff and Sales staff for drug information and consultation to individual patient situations. Provides benefit consultation services to SummaCare clients including Summa entities, and participates in client meetings, presentations, and performance reporting to key accounts.
Oversees coverage determinations. Acts as initial review for coverage requests as well as for drugs covered under medical benefit. Reviews first‑line appeals, when original review was conducted by PBM.
Establishes relationships with managed care divisions of pharmaceutical manufacturing representatives.
Develops, implements, and oversees utilization and disease management programs and incentives designed to improve quality of care, member medication compliance, and maintain cost‑effectiveness.
Performs all job functions with integrity. Provides timely internal and external customer service in cooperative, professional and respectful manner.
Skills and Abilities Communication – ability to communicate complex information verbally and in written form including policies, procedures, financial, legal, and technical documents; ability to provide guidance required to implement strategic programs; ability to supervise work within and/or across departments; ability to negotiate and persuade professionals, board members and general public.
Analytical – highly complex: designing, developing and implementing high‑complexity programs, products, technical systems, policies that affect overall direction of the company; proofreading completed work to find and correct errors; requires excellent attention to detail.
Other Skills and Abilities
Read, analyze, and interpret general business periodicals, professional journals, technical procedures, and government regulations.
Demonstrate strong leadership and managerial skills.
Make sound decisions and recommendations based on consideration of facts, priorities, resources, and alternatives.
Organize and manage time to accurately complete tasks within designated time frames in fast‑paced environment.
Maintain current knowledge of and comply with regulatory and company policies & procedures.
Maintain confidentiality of patient and business information.
Flexible: ability to adjust work hours to meet business demands.
Physical Effort and Dexterity
Sit for prolonged periods of time.
Lift up to 25 pounds.
Manual dexterity to operate computer, phone, and standard office machines.
Visual Acuity, Hearing, and Speaking
Candidates whose disabilities make them unable to meet these requirements will still be considered fully qualified if they can perform essential functions of job with reasonable accommodation.
Scheduling Occasional overtime work required during peak business periods as scheduled by supervisor. Occasional travel which may require use of personal auto to attend meetings, conferences, workshops, and/or seminars.
Safety Hazards and Environment Minimal hazards. General office working conditions.
Equal Opportunity Employer / Veterans / Disabled Equal Opportunity Employer. Veterans and Disability Qualified Applicants are encouraged to apply.
Benefits
Basic Life and Accidental Death & Dismemberment (AD&D)
Supplemental Life and AD&D
Dependent Life Insurance
Short‑Term and Long‑Term Disability
Accident Insurance, Hospital Indemnity, and Critical Illness
Retirement Savings Plan
Flexible Spending Accounts – Healthcare and Dependent Care
Employee Assistance Program (EAP)
Identity Theft Protection
Pet Insurance
Education Assistance
Daily Pay
Salary $80.17/hr - $120.26/hr
Summa Health offers a competitive and comprehensive benefits program to include medical, dental, vision, life, paid time off as well as many other benefits.
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– Akron, Ohio (Hybrid)
Employment type : Full Time, 40 Hours per week
Salary range : $80.17/hr – $120.26/hr (base salary, exclusive of bonuses)
Summary Provides Clinical Pharmacological leadership to the health plan, membership and provider network. Provides oversight for pharmacy and therapeutic issues, and ensures compliance with pertinent government regulations and standards.
Educational Requirement Advanced Degree or may substitute with 6 years of like experience.
Required Experience 5+ years performing same or similar responsibilities. Relevant experience includes working in Pharmacy Benefit Management either in a Health Insuring Corporation or other managed care environment and experience working with Medicare Part D. Minimum 5 years direct supervisory experience also required.
Required Licenses & Certificates Registered Pharmacist in State of Ohio. Valid driver license.
Software and Data Entry Requirement None required.
Essential Functions and Responsibilities
Reviews, monitors and recommends changes to prescription programs and formulary including limitations, pre‑authorizations, exceptions and non‑covered items. Oversees development and administration of Medicare Part D formulary.
Oversees selection, implementation, and performance of the Pharmacy Benefit Manager (PBM).
Assures regulatory compliance of the Pharmacy Department. Provides guidance to staff on operational and regulatory issues including compliance with CMS (Medicare MA and Part D), NCQA, Fraud Waste & Abuse, and ODI guidelines.
Develops and analyzes drug utilization reports, and makes recommendations to Senior Management for interventions.
Oversees Contracting Strategies as related to Pharmacy and Therapeutic issues. Manages Pharmacy & Therapeutics Committee including development of agendas and meeting materials. Reviews all committee actions and recommendations with Clinical Pharmacist and Chief Medical Director.
Serves as resource to HSM staff and Sales staff for drug information and consultation to individual patient situations. Provides benefit consultation services to SummaCare clients including Summa entities, and participates in client meetings, presentations, and performance reporting to key accounts.
Oversees coverage determinations. Acts as initial review for coverage requests as well as for drugs covered under medical benefit. Reviews first‑line appeals, when original review was conducted by PBM.
Establishes relationships with managed care divisions of pharmaceutical manufacturing representatives.
Develops, implements, and oversees utilization and disease management programs and incentives designed to improve quality of care, member medication compliance, and maintain cost‑effectiveness.
Performs all job functions with integrity. Provides timely internal and external customer service in cooperative, professional and respectful manner.
Skills and Abilities Communication – ability to communicate complex information verbally and in written form including policies, procedures, financial, legal, and technical documents; ability to provide guidance required to implement strategic programs; ability to supervise work within and/or across departments; ability to negotiate and persuade professionals, board members and general public.
Analytical – highly complex: designing, developing and implementing high‑complexity programs, products, technical systems, policies that affect overall direction of the company; proofreading completed work to find and correct errors; requires excellent attention to detail.
Other Skills and Abilities
Read, analyze, and interpret general business periodicals, professional journals, technical procedures, and government regulations.
Demonstrate strong leadership and managerial skills.
Make sound decisions and recommendations based on consideration of facts, priorities, resources, and alternatives.
Organize and manage time to accurately complete tasks within designated time frames in fast‑paced environment.
Maintain current knowledge of and comply with regulatory and company policies & procedures.
Maintain confidentiality of patient and business information.
Flexible: ability to adjust work hours to meet business demands.
Physical Effort and Dexterity
Sit for prolonged periods of time.
Lift up to 25 pounds.
Manual dexterity to operate computer, phone, and standard office machines.
Visual Acuity, Hearing, and Speaking
Candidates whose disabilities make them unable to meet these requirements will still be considered fully qualified if they can perform essential functions of job with reasonable accommodation.
Scheduling Occasional overtime work required during peak business periods as scheduled by supervisor. Occasional travel which may require use of personal auto to attend meetings, conferences, workshops, and/or seminars.
Safety Hazards and Environment Minimal hazards. General office working conditions.
Equal Opportunity Employer / Veterans / Disabled Equal Opportunity Employer. Veterans and Disability Qualified Applicants are encouraged to apply.
Benefits
Basic Life and Accidental Death & Dismemberment (AD&D)
Supplemental Life and AD&D
Dependent Life Insurance
Short‑Term and Long‑Term Disability
Accident Insurance, Hospital Indemnity, and Critical Illness
Retirement Savings Plan
Flexible Spending Accounts – Healthcare and Dependent Care
Employee Assistance Program (EAP)
Identity Theft Protection
Pet Insurance
Education Assistance
Daily Pay
Salary $80.17/hr - $120.26/hr
Summa Health offers a competitive and comprehensive benefits program to include medical, dental, vision, life, paid time off as well as many other benefits.
#J-18808-Ljbffr