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SalaryCOMPANY OVERVIEW
Zing Health is a tech-enabled insurance company making Medicare Advantage the best it can be for those 65-and-over. Zing Health has a community-based approach that recognizes the importance of the social determinants of health in keeping individuals and communities healthy. Zing Health aims to return the physician and the member to the center of the health care equation. Members receive individualized assistance to make their transition to Zing Health as easy as possible. Zing Health offers members the ability to personalize their plans, access to facilities designed to help them better meet their healthcare needs and a dedicated care team. For more information on Zing Health, visit www.myzinghealth.com.
SUMMARY DESCRIPTION:
The Clinical Operations Pharmacist is responsible for contributing to the success of the pharmacy department’s goals and objectives.
The pharmacist is responsible for supporting and leading various pharmacy operations programs including PBM and MTM program oversight. The pharmacist will work in conjunction with key internal and external stakeholders to drive Zing’s Part D strategy and subsequently evaluate performance and ensure that such work in compliance with CMS rules and requirements.
The pharmacist will work with pharmacy leadership to establish and execute department goals, objectives, quality measures and meet all regulatory and compliance requirements.
Requirements:ESSENTIAL FUNCTIONS:
- Part D Formulary & Operations
- Provides oversight, monitoring, and clinical support Part D & B pharmacy benefits collaboration with PBM
- Analyzes and provides clinical recommendations based on pipeline surveillance data, formulary reviews, and presentations
- Utilize PBM or internal databases to extract and analyze pharmacy utilization and cost data
- Collaborates with PBM and internal staff to resolve member, provider, and pharmacy clinical issues when necessary
- Participates in PBM P&T committee, formulary advisory committee, and monthly Formulary Reference File (FRF) files.
- Oversees the annual review of formularies and clinical pharmacy strategies, including a competitive analysis, cost-benefit review of programs, and trend review by therapeutic class
- Develop continuous monitoring activities and processes to ensure CMS compliance requirements
- Medical Part B Drug Program
- Supports Zing leadership on the following:
- Development and oversight of Medical (Medicare Part B) drug utilization/cost and management program
- Analyzes and provides clinical recommendations based on pipeline surveillance data, utilization trends
- Development of Part B Step Therapy programs
- Develop network strategy with provider network
- Quality & STAR measures
- Responsible for leading clinical Part D measures such as medication adherence, gaps in therapy (e.g., statins in diabetes)
- Design, implement, maintain, and monitor quality initiatives
- Develop and integrate quality programs aimed to improve patient care outcomes, such as increasing medication adherence, closing gaps in care, and improving medication review rates
- Collaborate with Pharmacy Benefit Manager (PBM) on the implementation of operational programs, reporting, and analyses to assist with the plan’s Medicare Part D clinical Display and STAR ratings
- Complete medication reviews for identified members as required
QUALIFICATIONS AND REQUIREMENTS:
- Doctor of Pharmacy (Pharm D.) Required
- Must be licensed as a pharmacist and in good standing with Board of Pharmacy
- Minimum 2+ years in pharmacy
- Managed care or PBM experience highly preferred
- Knowledge of formulary utilization management practices
- Knowledge of pharmaceuticals and disease states to provide advice and consultation to providers and members, and recommend changes to the formulary
- Knowledge of or experience with Medicare Part B & D
- Strong understanding of Medicare Part D rules and requirements, Medicare product offerings, the health plan space, PBM business practices, and vendor management
- Requires analytical ability to independently research/ summarize data on drug utilization and spend.
REQUIREMENTS
- Excellent written and verbal communication skills
- High degree of professionalism and confidence
- Ability to interact effectively with all levels of management
- Must be self-motivated and capable of working independently with minimal supervision
- Can organize, facilitate, and manage several projects simultaneously
- Must be flexible and able to constantly review and reset priorities Operates with flexibility in changing business and government regulated environment
- Proven track record on consistently achieving desired results
- Organized and can simultaneously execute through multiple projects and priority
- Self-starter, possessing willingness and ambition to work through ambiguity
- Creative, and critical thinker
