CommunityCare HMO, Inc.
Pharmacy - Director Pharmacy Services 146-7001
CommunityCare HMO, Inc., Tulsa, Oklahoma, United States, 74145
Pharmacy - Director Pharmacy Services 146-7001
Tulsa, OK, USA
Job Description Posted Thursday, December 4, 2025 at 7:00 AM
JOB SUMMARY:
Oversee all aspects of operations of the Pharmacy department including delivery of pharmacy benefits, network, administration, budgeting, reporting, and claims adjudication. Supervise all employees of the Pharmacy department.Provide clinical pharmacy direction for the health plan, including but not limited to prior-authorization processes. Work with Medical Directors in the education of providers regarding pharmacy costs, utilization and other quality improvement data.Provide drug utilization review and intervention targeting high utilizing physicians reviewing prescribing patterns including non-preferred drugs and quality indicators. Make recommendations on prescribing practices to reduce costs. Work with PBM on development of drug review evaluations for the P&T Committee. Assist in the development of goals and objectives for clinical pharmacy programs. Serve as a resource for drug information. Coordinate formulary development for all health plan products and work with PBM to assure accuracy of formulary information. Develop and maintain policies & procedures for clinical pharmacy operations.
KEY RESPONSIBILITIES:
Supervise all work-product and employees of the Pharmacy department. Provide direction to department personnel and support to other departments regarding pharmacy benefits, claims adjudication, and formulary changes.
P&T Committee - Work with PBM on development of clinical presentations and drug utilization review programs. Provide clinical input to administrative staff in the preparation of Committee minutes.
Clinical Liaison to PBM - Work with PBM to direct clinical programs, including Patients-At-Risk. Rotate attendance with Medical Director at PBM National P&T meetings.
Formulary Development - Coordinate formulary development and maintenance with P&T Committee and PBM to assure accuracy of adjudication files, CMS files, print and web formulary files.
Prior-Authorization Programs - Responsible for inital drug utilization management determinations. Work with the Medical Director and pharmacy help-desk in the review process of prior-authorization requests.
Internal/External Meetings - Provide clinical pharmacy input at various internal and external meetings, as necessary.
Academic Detailing - Work with PBM & Medical Directors to develop clinical education targeting high prescribers, meet with target physicians to discuss prescribing goals & objectives based on clinical education programs. Develop educational information for provider newsletters and the company website.
Perform other duties as assigned.
QUALIFICATIONS:
Demonstrated understanding and application of managed care concepts and terminology.
Extensive experience in management of pharmacy clinical programs.
Proficient in Microsoft applications.
Successful completion of Health Care Sanctions background check.
Excellent analytical, organizational, and decision making skills.
Completion of Medicare/Medicaid Sanction.
Possess strong oral and written communication skills.
EDUCATION/EXPERIENCE:
Graduation from an accredited School of Pharmacy. PharmD degree preferred.
Current and active unrestricted license to practice pharmacy in the state of Oklahoma.
Minimum of 3 years work experience in a managed health care environment specific to pharmacy management activities.
CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin
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Job Description Posted Thursday, December 4, 2025 at 7:00 AM
JOB SUMMARY:
Oversee all aspects of operations of the Pharmacy department including delivery of pharmacy benefits, network, administration, budgeting, reporting, and claims adjudication. Supervise all employees of the Pharmacy department.Provide clinical pharmacy direction for the health plan, including but not limited to prior-authorization processes. Work with Medical Directors in the education of providers regarding pharmacy costs, utilization and other quality improvement data.Provide drug utilization review and intervention targeting high utilizing physicians reviewing prescribing patterns including non-preferred drugs and quality indicators. Make recommendations on prescribing practices to reduce costs. Work with PBM on development of drug review evaluations for the P&T Committee. Assist in the development of goals and objectives for clinical pharmacy programs. Serve as a resource for drug information. Coordinate formulary development for all health plan products and work with PBM to assure accuracy of formulary information. Develop and maintain policies & procedures for clinical pharmacy operations.
KEY RESPONSIBILITIES:
Supervise all work-product and employees of the Pharmacy department. Provide direction to department personnel and support to other departments regarding pharmacy benefits, claims adjudication, and formulary changes.
P&T Committee - Work with PBM on development of clinical presentations and drug utilization review programs. Provide clinical input to administrative staff in the preparation of Committee minutes.
Clinical Liaison to PBM - Work with PBM to direct clinical programs, including Patients-At-Risk. Rotate attendance with Medical Director at PBM National P&T meetings.
Formulary Development - Coordinate formulary development and maintenance with P&T Committee and PBM to assure accuracy of adjudication files, CMS files, print and web formulary files.
Prior-Authorization Programs - Responsible for inital drug utilization management determinations. Work with the Medical Director and pharmacy help-desk in the review process of prior-authorization requests.
Internal/External Meetings - Provide clinical pharmacy input at various internal and external meetings, as necessary.
Academic Detailing - Work with PBM & Medical Directors to develop clinical education targeting high prescribers, meet with target physicians to discuss prescribing goals & objectives based on clinical education programs. Develop educational information for provider newsletters and the company website.
Perform other duties as assigned.
QUALIFICATIONS:
Demonstrated understanding and application of managed care concepts and terminology.
Extensive experience in management of pharmacy clinical programs.
Proficient in Microsoft applications.
Successful completion of Health Care Sanctions background check.
Excellent analytical, organizational, and decision making skills.
Completion of Medicare/Medicaid Sanction.
Possess strong oral and written communication skills.
EDUCATION/EXPERIENCE:
Graduation from an accredited School of Pharmacy. PharmD degree preferred.
Current and active unrestricted license to practice pharmacy in the state of Oklahoma.
Minimum of 3 years work experience in a managed health care environment specific to pharmacy management activities.
CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin
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