DIRECTOR, PHARMACY BENEFIT MANAGEMENT (PBM) ADVISORY SERVICES
Responsible for leading strategy development and execution to provide the most cost-effective Pharmacy Benefit Management (PBM) programs and services to member hospitals. Execute the developed marketing strategy which involves interacting with hospitals and vendors to identify savings and clinical management opportunities, overseeing the successful implementation of identified opportunities and ensuring the actual savings are achieved, maximize participation among member hospitals and enhance the relationship between all parties. Collaborates with internal resources to provide analytics and support services, including identification of business and service issues, and facilitation of resolution, as required. Responsible for directing aggregation and insurance group purchasing contract activities related to the Pharmacy Benefit Management (PBM) program.
ESSENTIAL DUTIES AND RESPONSIBILITIES
DIRECT ACTIVITIES RELATED TO MARKETING THE PBM PROGRAM
- Utilize broad knowledge of PBM industry to set and execute marketing strategy.
- Communicate PBM knowledge including emerging trends in a manner designed to educate and influence businesses in terms of plan design, outcomes and disease management.
- Use data to support and direct recommendations to member hospitals and other potential consumers regarding benefits/cost and methods of cost control.
- Utilize data base information regarding PBM plan design and administration of contracts to impact plan design and disease management outcomes.
- Work with key partners to validate requirements, costs and benefits of programs.
- Create and work with internal resources to analyze opportunities for program participants.
- Direct the creation of all agreements and related documents such as vendor contracts.
- Participate in all phases of PBM contracts and support for PBM participants.
- Respond to and ensure timely resolution of PBM inquiries and issues.
- Proactively consult with members, vendors and benefits professionals on PBM on ongoing basis and by oversight of implementation and on-site vendor reviews.
- Oversee budgeting and financial reporting for ongoing operations.
- Utilize knowledge and experience with PBM’s role in population health management and the use of clinical tools, such as drug utilization review and disease management, to encourage the best clinical outcomes for patients.
- Foster aggregation of prescription drugs purchasing, enabling lower prices through price discounts, rebates and efficiencies.
- In conjunction with CHART, impact disease management through the use of utilization data.
- Manage communications between vendors, participating hospitals and other partners, relaying issues and opportunities.
- Collaborate with vendors to develop and maintain a quarterly reporting analysis package.
- Maintain a thorough understanding of PBM business including: retail, mail order, specialty care, E-prescribing, national trends, plan design and analytical financial data.
- Maintain a thorough understanding of health system clients’ unique needs as it relates to the delivery of pharmacy benefits including but not limited to: 340B, own use medications, specialty pharmacy and GPO purchasing.
- Conduct bi-monthly operational calls with PBM partners to discuss individual escalated issues in addition to overall initiatives to achieve organizational goals, including program design and pilot programs.
OPERATIONS AND PLANNING
- Utilizing internal resources, exercise financial analysis acumen to support the PBM effort.
- Keep the Insurance Services team informed on PBM activities and assist in identifying carrier and vendor partner’s trends and ensures participating hospitals and vendor partner needs are being met.
- Develop business cases for related new programs and services to quantify project benefits, costs and impact.
- Advise, recommend and justify critical decisions to leadership group with business partners.
- Oversee the completion of periodic PBM audits and present results to participating hospitals.
MANAGERIAL DUTIES AND RESPONSIBILITIES
- Approaches the managerial process with a solid understanding of how dynamics, personalities and talents work together to build a strong team.
- Implements office procedures and protocols in accordance with organizational policies. Determines project priorities and delegates as needed.
- Creates a supportive environment that welcomes different perspectives, reinforces the importance of each team member’s role and encourages them to work from their strengths.
- Provides leadership by clearly communicating expectations for projects, builds methods to help team members report progress and evaluates results to determine if goals were achieved.
- Listens to all sides, offers a fair perspective that quickly resolves the issue and works with team members to develop conflict resolution skills.
- Exhibits integrity, builds trust and rapport with team members to encourage honest conversations that result in better work. Interpret and ensure self and subordinate employees are in compliance with Association policies and procedures.
QUALIFICATIONS AND WORK ENVIRONMENT
- B.S. Pharm. or Pharm D degree
- A minimum 5-7 years PBM work experience, e. with providers or as consultant with mid- senior level contacts Pharm D preferred
- Ability to identify, create and promote PBM business opportunities
- Ability to build relationships and align with key players positioned at the forefront of PBM trends and movements
- Ability to connect with national thought leaders including, national vendors, consultants, PBM experts and mid and senior level management
- Excellent analytical skills
- Project management skills and experience
- Ability to interpret analytical data
- Strong verbal and written communication skills including ability to make public presentations and to facilitate group meetings and negotiations with Business leaders
- Excellent customer service and interpersonal communication skills, with ability to interact with all levels in an organization
- Ability to draw upon extensive knowledge and relationships to influence, identify issues and develop appropriate policy responses to accomplish challenging goals
- Demonstrated ability to work and influence at the VP level and above in a diplomatic fashion
- Ability to research potential insurance vendors and/or insurance products for potential aggregation opportunities
- Knowledge and experience with PBM’s role in population health management
- Knowledge and experience of aggregators and coalitions
- Thorough knowledge of retail pharmacy business and clinical pharmacy operations
- Thorough knowledge of GPO/own-use and 340B pricing and regulations
- Thorough knowledge of emerging trends in PBM
- Thorough knowledge of pharmacy benefit management programs and terminology
- Working knowledge of self-funded health benefits, services and programs
- Personal computer proficiency including use of database applications and MS Word, Excel and PowerPoint
LICENSES / CERTIFICATIONS
- Pharmacy License (It’s ok if the license is expired)
RECRUITER NOTES: The vision of an ideal candidate for the PBM Director role is someone who not only has proven leadership and strategic qualities within the Pharma Industry, but also has a gift/knowledge in partnering, crafting and delivering custom PBM solutions at a national and executive level. Key responsibilities include collaborating and strategizing with internal team to enhance existing customer relationships, develop and foster new business relationships, identify savings and clinical management opportunities, partner with key vendors and potentially seek out new ones, assist with contract renegotiation or RFP’s, as well as ensure all Federal Guidelines and Compliance (aka HIPPA regulations) are met.
This is truly a great opportunity for someone who has been either a Pharmacist, has been a consultant at an enterprise level Insurance Agency, has worked inside a large-scale PBM and/or has felt the pressure and high-demand of the Pharmacy Consulting world and is really just looking for a change of pace, while still being challenged and helping people at the same time.
The Director will be joining an amazing, supportive team with unlimited opportunities within a tremendous organization!!!