Director, Pharmacy Operations

Who We Are

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities.

Job Summary
Reporting to the VP, Pharmacy, the Director, Pharmacy Operations is responsible for directing pharmacy benefit management (PBM) and operational excellence for all lines of business. Key responsibilities include: a)oversight of operational components performed by the pharmacy benefits management vendor; timeliness and accuracy of formulary drug coding and benefit design implementation b)interpretation, implementation and adherence with state and federal regulatory and compliance requirements c)design, develop and monitoring of key performance indicators, including production of management reporting and executive level dashboards to communicate performance, d) direct the evaluation and implementation of new, value added offerings to enhance the member experience, e)direct the strategy, planning and implementation of PBM system migrations and IT application enhancements, f) collaborate with pharmacy management team to develop and implement trend mitigation opportunities, g) manage the deliverables, performance and development of direct reports.

Key Responsibilities/Duties - what you will be doing

• Directs business plan implementation and continuously monitors the performance of pharmacy operations for all lines of business:
- Perform ongoing monitoring of PBM vendor performance. Oversee ongoing evaluation of current operational strategy, directing improvements and process reengineering to ensure customer satisfaction while mitigating compliance risks
- Develop and implement drug coding and benefit implementation, directing work plans, testing strategy and defect resolution
- Oversee operational metrics for all functions delegated to PBM vendor. Track and trend performance metrics, making recommendations for performance improvement and problem resolution
- Develop operational metrics and dashboards to evidence compliance to management team and senior leaders
- Monitor industry trends and evolving methodologies to identify process improvement opportunities
- Evaluate and develop key performance indicators to inform current and future business requirements

• Directs the interpretation, implementation, and adherence with state and federal regulatory and compliance requirements
- Monitor and implement changes related to state and federal regulatory requirements for all business lines (e.g., CMS, State of MA, RI, NH, ME and CT)
- Lead pharmacy operations- related deliverables and inputs to regulatory and employer group audits
- Implement and monitor quality assurance process and change control measures
- Directs pharmacy operations initiatives in support of enterprise operating priorities
- Lead implementation of medical trend mitigation opportunities for all business lines
- Facilitate inputs into new product designs and annual benefit changes
- Oversee pharmacy operations components of client RFP's and employer group requests
- Lead and manage pharmacy operations strategy. Collaborate with IT to prioritize requirements, ensure accuracy and build business requirements for new initiatives and operational priorities

• Directs the evaluation and implementation of new, value-added offerings to improve member experience
- Collaborate with pharmacy management team, Product Strategy, Sales and Marketing to anticipate market demands and develop new products and services
- Work with PBM to identify web and technology enhancements that could produce marketplace differentiation
- Lead cross-functional stakeholder workgroup focused on improving efficiencies and streamlining processes relating to pharmacy benefit operations and member experience
- Manage the deliverables, performance, and development of direct reports: (TBD)

- Other duties and projects as assigned

Qualifications - what you need to perform the job

EDUCATION, CERTIFICATION AND LICENSURE:

• Master's degree in operations or business administration preferred

EXPERIENCE (minimum years required):

• 10-15 years of health care related experience in medical, pharmacy, hospital, or managed care administration. Superior operations management skills required, including knowledge of pharmacy benefit implementation and pharmacy benefit management systems.
• 5-10 years of management experience, supervising seasoned professionals, having demonstrated success with program implementation and/or measurement, budget, and vendor management. Ability to articulate strong understanding of state and federal regulatory and compliance requirements. Must have a proven ability to achieve goals and deliver bottom-line results.

SKILL REQUIREMENTS:

• Excellent interpersonal skills are required. A high level of diplomacy and effective stakeholder management is necessary to anticipate, recognize and deal effectively with politically sensitive issues and to interact with a wide range of professionals. Role requires frequent verbal, written and in-person communication with enterprise departments, external vendors, and regulatory agencies. Displays a strong presence that will engender confidence amongst internal staff and stakeholders. Possesses excellent leadership skills with the ability to guide and inspire others

WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS (include special requirements, e.g., lifting, travel):

• Must be able to work under normal office conditions and work from home as required.
• Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
• May be required to work additional hours beyond standard work schedule.

DISCLAIMER
The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.

Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity

Point32Health is committed to making diversity, equity, inclusion, accessibility and health equity part of everything we do-from product design to the workforce driving that innovation. Our Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity team's strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

COVID Policy

Please note: As of January 18, 2022, all employees - including remote employees - must be fully vaccinated. This position will require the successful candidate to show proof of full vaccination against COVID-19. Point32Health is an equal opportunity employer, and will consider reasonable accommodation to those individuals who are unable to be vaccinated consistent with federal, state, and local law.