Medical Benefit Clinical Program Integrity Director/PharmD required - REMOTE Job at Prime Therapeutics
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Job Posting Title
Medical Benefit Clinical Program Integrity Director/PharmD required - REMOTE
Job Description Summary
This position is responsible for product ownership, enhancement and improvement for current Medical Pharmacy programs and developing, implementing, integrating and coordinating medical pharmacy products and services for the company across all business units as a comprehensive solution. Responsibilities include, but are not limited to, review of each current program functionality and results and managing end to end process for enhancements, improvements (including identifying deficiencies), and efficiencies, program integrity, conceptualizing products, coordinating market research, enhancing existing products, and integrating, implementing, and launching new and enhanced products to increase revenues for the company. Develops and leads a formal process to review and determine opportunities for improvement and enhancement which may include unique solutions for each client. Accountable to drive strategic initiatives within the organization and is responsible for impacting results and change often without direct line control. Influences change and decision-making across stakeholders, both internal and external, which is critical to the success and achievement of desired outcomes.
Job Description
- Serves as end to end product owner, responsible for program integrity of PA, PSCE, SOS and Fee Schedule where applicable clinically and operationally. Works collaboratively with operational teams, (including and especially operational team product owners) to enhance and improve current programs.
- Evaluates and designs enhancements, as well as new medical pharmacy products and solutions. This includes utilization management protocols (including PA and PSCE), unique pathway and reimbursement programs, fee schedule strategies, potential site of service opportunities, medical formularies, predictive models where appropriate, clinical rules, and member and provider engagement strategies across medical and pharmacy.
- Evaluates and prepares data, question sets and ideas for internal quarterly business reviews for team discussions and follows through on all action items, working collaboratively with Sales Coordination Director. Provides strategic direction to the reviews.
- Works collaboratively and in conjunction with Director, Clinical Oncology Product Development on anything involving oncology products or management
- Works to develop and support medical formulary initiatives across the company for all business units.
- Develops and executes entire process for existing programs, program integrity of current programs, and potential new products to include but not limited to: brainstorming, data analysis requests, action plans, implementation, contract language and pricing, educational and client materials and program maintenance.
- Develops and executes prototype marketing and implementation project plans.
- Develops sample case studies and satisfaction surveys as appropriate. Coordinates the development of new product concepts across the organization, including analysis of market opportunity and synergy with current operations.
- Monitors performance of existing products by conducting analyses including, but not limited to, product performance and savings, achievement of program goals for customers, sales and renewals, utilization, vendor relationships, costs and margins, and market share.
- Evaluates competitive industry data to improve the performance of existing products or create product extensions. Develops internal and external reports to show product performance. Develops product improvements and enhancements.
- Serves as the product expert for internal and potentially as needed external customers. Understands product mechanics, value proposition, competitive position and opportunities for enhancements and growth.
- Supports implementation of and ongoing operations including vendor relationships, where applicable, and contracts, systems and operational workflow development, reporting and pricing strategies.
- Develops proposal language to describe new product capability and conduct formal training sessions to orient organization and communicate new product capability and launch of enhanced features.
- Presents new and enhanced product capability to focused prospects to test product performance against specifications.
Responsibilities
- Medical pharmacy strategy and management. Experience in either Managed Care, Health Plan, OR PBM.
- Must have exceptional knowledge of current dynamics in medical pharmacy and in the healthcare system, including both medical and pharmacy operations and programs/products for Commercial, Medicare, and Medicaid, and be able to coordinate and integrate across the company to create a cohesive product.
- Must have significant clinical knowledge, business acumen, and industry insight.
- In depth understanding and experience of the current medical pharmacy market and dynamic, and any relevant current or upcoming regulatory or legislative changes effecting medical benefit drug management.
- Exceptional knowledge of medical and pharmacy operations, products, and programs with strong strategic thinking and planning.
- Prior experience and proven success in launching new products or services to go-to-market for Commercial, Medicare and Medicare rules and guidelines surrounding program areas of focus, and/or Medicaid market segments.
- Proven ability to build and maintain relationships across diverse functional teams and leaders to drive fact-based decision making, execute with the appropriate level of urgency, and achieve desired results.
- Ability to balance multiple accountabilities and projects, lead and motivate people across the enterprise organization, and effectively manage organizational changes.
- Experience in the coordination of and collaboration of work teams and a proven track record of success while working in any of the following functional areas: Clinical Operations, Medical Operations, Product Management and Development, Marketing or Account Management.
- Must possess strong organizational, project management, and analytical skills.
- Strong verbal and written communication skills are essential.
- Process and detail oriented with disciplined implementation methodologies and a keen ability to execute.
Work Experience
Work Experience - Required:
Health Plans, PBM (Pharmacy Benefit Management), Pharmacy, Product Innovation/Development
Work Experience - Preferred:
Education
Education - Required:
Bachelors - Pharmacy
Education - Preferred:
Certifications
Certifications - Required:
RPH - Registered Pharmacist - Pharmacy - Pharmacy
Certifications - Preferred:
Potential pay for this position ranges from $117,860.00 - $200,360.00 based on location, experience and skills.
Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law.
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