Director of Pharmacy - PRIDE Health (New York, NY)

Prestigious managed care company is looking for a Pharmacy Director. The Pharmacy Director will provide clinical oversight for the Pharmacy program in New York and New Jersey. This includes day-to-day leadership for PBM oversight, coordination with Regulatory for all CMS requirements, coordination with other areas of Medical Management, and oversight of utilization management activities. Essential Duties and Responsibilities: Primary responsibilities include translating clinical information into functional specifications within a clinical rule set to be implemented at pharmacy point-of-care on programs such as but not limited to: generic product program, formulary compliance, prior authorization and step-therapy, quality compliance, DUR & reviewing prescriber patterns. Identify opportunities to improve adherence to national guidelines and the delivery of care for Medicare and Medicaid. This includes collaboration with other departments for quality initiatives such as MTM, adherence programs, etc. Coordinate clinical activities with Medical Management, including but not limited to, Provider Partnership programs, Disease and Case Management coordination. Develop and maintain additional clinical program and/or communication materials and its customers and stakeholders: members, providers, internal personnel. Provide clinical information support to internal and external customers. Coordinate projects with other departments including Quality Improvement, Medical Management, Regulatory/Legal, and Ancillary as required. Monitor Fraud & Abuse and ensure regulatory compliance. Manage drug formularies, drug trend and drug spend PMPM for all lines of business including Medicare, Medicaid and Commercial. Provide support for operational activities, including issues identification, management and resolution. These operational activities will need to be coordinated with both internal and external partners. Support the Vice President in the creation and execution of an annual Pharmacy business plan. Manage a team on Pharmacy managers and analysts, responsible for the daily monitoring of all Pharmacy activities including coordination with the PBM and with Member Services for all member and provider inquiries. Provide oversight for regional pharmacy students and associated preceptor responsibilities. Education: 4 year degree and Registered pharmacist. 8+ years managed care experience which must include review and interpretation of medical and pharmacy claims. 2+ managing direct reports. Knowledge of the PBM (pharmacy benefits management) industry desired. Strong clinical skills, and the ability to apply sound clinical judgment to a variety of situations. Proficiency in drug literature and clinical trial evaluation, including proficiency with electronic databases preferred. Knowledge of formulary systems, medical and pharmacy claims, and managed care. Understanding of the PBM/managed care business. To View Additional Job Opportunities, please visit our website at: www.pride-healthcare.com. Please fax or email resume to: Amy Rubinstein Vice President of Healthcare Recruitment PRIDE Health 420 Lexington Avenue, Suite 2220 New York, NY 10170 amy.rubinstein@pride-healthcare.com http://www.pride-healthcare.com 212-235-5364 (direct) 212-599-3427 (fax)

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