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Director, Medicare Part-D Coverage Determinations Clinical Pharmacy Operations

Rancho Cordova, CA, USA | Centene Corporation

  • Industry:
    Healthcare - Hospitals
  • Position Type:
  • Functions:
    General Management
    Operations / Production
  • Experience:
    3-5 years
Job Description:
87 people have viewed this job

Develop, implement and oversee the clinical pharmacy operations department that serves multiple product lines in both centralized and regional environments with multiple locations.

Oversee the clinical pharmacy operations business unit, including the support of client implementation of prior authorization, drug utilization review programs, and plan specific management initiatives 

Ensure regulatory compliance and turnaround times by overseeing the staffing and scheduling of clinical pharmacists and technicians 

Direct the development of new cost reduction, pricing, quality improvement and revenue enhancement activities 

Develop and manage the operating and capital equipment budgets 

Monitor performance and provide recommendations to improve department efficiency and quality 

Support the development of organizational policies and procedures, including pharmacy service quality, pharmacy utilization management and achievement of company goals 

Oversee the clinical operations unit to ensure that relevant performance standards are met for all clients 

Oversee the resolution of disputes, grievances and complaints involving pharmacy program issues 

Participate in internal and external accreditation initiatives, task forces, committees, meetings and other activities 

Support clinical programs that support accreditation for HEDIS, URAC, etc.

Consultation with staff in the field

Senior Clinical staff will have direct oversight of qualified clinicians accountable for decisions affecting consumers

Education/Experience: PharmD degree or advanced pharmacy degree. MBA or advanced degree in Business preferred. 7+ years of clinical or operational pharmacy services experience, including 5+ years of pharmacy benefit management experience. Strong understanding of clinical, operational, and regulatory compliance programs and services. PBM, managed care, or quality improvement experience preferred. 

License/Certification: Current state’s Pharmacist license without restrictions

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