Kaiser Permanente Pharmacy Benefits Manager - Central Pharmacy in Sterling, Virginia
This position provides leadership for the MAS Pharmacy Benefits Team and supports the design and development of market competitive, cost-effective, quality based drug benefits which meet applicable federal and state regulatory requirements. To oversee the administration of the pharmacy benefits and processes and support data/reporting through the production of reports for cost, utilization, and outcomes analysis in the drug benefit area.
Leads, interviews, selects, orients, instructs, evaluates, and disciplines the pharmacy benefits supervisor and pharmacy benefits specialists.
Provides leadership and direction for the accurate and consistent administration, monitoring, processing and reporting of benefits, formulary, and utilization information including ongoing support for Medicare Part D, FEHB, Self-Funded, Medicaid, Marketplace Exchange and commercial benefit requirements.
Facilitates the development, rollout, and implementation of pharmacy benefits and any enhancements to include project implementation.
Serves as the subject matter expert for the drug benefits and pharmacy relevant medical benefits responding to inquiries on benefit questions, benefit administration capabilities, proposals, and authorization requests.
Keeps up to date on competitor's drug benefits in the market and serves as a knowledge source for the benefits while representing the department in regional and interregional workgroups.
Supports members of Sales and Account Management teams in providing accurate and timely information to clients and prospects about the drug benefits.
Works collaboratively with Product Development, Contracts and Benefits, Clinical Pharmacy and Pharmacy Operations to ensure that proposed/implemented drug benefits can be efficiently and accurately administered at the pharmacy point of sale.
Oversees and has accountability for the functions of the Pharmacy Prior Authorization help desk to include contract PBM compliance with applicable NCQA Standards.
Assures compliance to all regulatory rules and regulations specific to:
Drug Enforcement Agency (DEA)
State Boards of Pharmacy
Centers for Medicare and Medicaid Services
State Insurance Boards
Other regulatory/oversight entities as necessary
Performs other duties as directed.
Minimum two (2) years of specialized experience in pharmacy benefits,formulary management, Medicare, Medicaid, and/or Marketplace Exchange pharmacy regulations and compliance.
Minimum two (2) years of experience with Microsoft Word, Excel, PowerPoint.
Minimum two (2) Years of experience leading a team in attaining performance results.
- BS in pharmacy or Pharm.D. required.
License, Certification, Registration
- Licensed in the State of Maryland, Virginia, or District of Columbia as a Registered Pharmacist required.
- Excellent interpersonal, verbal, presentation and written communication skills.
Minimum two (2) years of staff leadership experience in a pharmacy operation setting preferred.
Minimum two (2) years of experience working at or with a Pharmacy Benefits Manager focused in areas of formulary management and/or pharmacy utilization functions preferred.
Minimum two (2) years of experience with Microsoft Access; and working analytical and data management skills preferred.
Minimum three (3) to four (4) years of specialized experience in pharmacy benefits, formulary management, Medicare, Medicaid, and/or Marketplace Exchange pharmacy regulations and compliance preferred.
Master's degree in business administration, health science administration or an equivalent combination of education and years of experience (combination of additional two (2) years) preferred.
Ability to define pharmacy benefit operational or program issues/needs and solutions.
Ability to work in and direct cross-functional project teams preferred.
Excellent influencing and consultative skills; and the ability to proactively identify and resolve issues and opportunities preferred.
TITLE: Pharmacy Benefits Manager - Central Pharmacy
LOCATION: Sterling, Virginia
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.