Primary City/State:

Mesa, Arizona

Department Name:

Pharm Benefits Mgmt-Misc

Work Shift:

Day

Job Category:

Pharmacy

Innovation and highly trained staff. Our Pharmacy team members play a critical role in ensuring the best care for our patients. Join a nationally recognized leader that values excellence and begin making a difference in people’s lives. Apply today.

Banner Health was named to Fortune’s America’s Most Innovative Companies list for the second year in a row for 2024 and named Most Trustworthy Companies in America by Newsweek. We’re proud to be recognized for our commitment to the latest health care advancements and excellent patient care.

In this role, you will serve as the Pharmacy Medicaid Director for Managed Pharmacy Services.  You will be the organizational expert to Pharmacy Medicaid, participate in relevant internal and external meetings and communications regarding all things that are part of participating as a MCO for Pharmacy Medicaid, such as bid, implementations, utilization management, quality, cost, reporting, regulatory and compliance initiatives. Experience in a pharmacy managed care environment in a health plan or Pharmacy Benefit Management environment will be helpful in this position. This is a remote work from home role, Monday - Friday 8AM - 5PM no mandatory call, no holiday rotation.

Your pay and benefits are important components of your journey at Banner Health. This opportunity includes the option to participate in a variety of health, financial, and security benefits. 

Your pay and benefits are important components of your journey at Banner Health. This opportunity includes the option to participate in a variety of health, financial, and security benefits. In addition, this position may be eligible for our Management Incentive Program as part of your Total Rewards package.

Banner Pharmacy Services is a recognized leader in healthcare and trusted partner in proactively providing innovative pharmacy services through excellence in integration, care coordination, medication management and services to make a difference in people's lives. Clinical Pharmacy Services is responsible for the management of the Banner formulary, development of standardized system wide clinical pharmacy services, and management of adverse drug event preventions. Clinical Pharmacy Services provides collaborative drug therapy management and educational interventions in patient care to optimize medication therapy, improve outcomes, promote wellness, and disease prevention. As a division, Banner Pharmacy services provides excellent patient care across our entire continuum through convenient access, improved medication outcomes and innovative pharmacy practices.

POSITION SUMMARY

This position is responsible for leading, coordinating, and developing clinical pharmacy activities and initiatives for the Managed Pharmacy Solutions (MPS) business line within Banner Pharmacy Services (BPS). This includes the creation and management of standard and a customized formularies that will be used by Banner Health’s risk based network partners. Responsible for the creation and maintenance of a Pharmacy and Therapeutics committee using current Banner medical and pharmacy subject matter experts as well as external experts. Responsible for the development, implementation, maintenance and evaluation of clinical quality and utilization management programs designed to lower drug expense while improving quality within the pharmacy benefit programs. Collaborates with internal and external clinical teams to review health plan analytics and various analytic material in order to improve overall medication use and quality. Serves as part of a team that develops and presents complex clinical ideas and strategies to diverse audiences including healthcare professionals, health plans, plan sponsors, and other strategic partners based on sound analytical information to non-medical personnel in an easy to understand format. Oversees a team of pharmacists, pharmacy technicians, and/or support staff to deliver clinical quality and utilization management programs and services. Serves as an integral member of the BPS Managed Pharmacy Solutions team and drives growth strategies in the pharmacy benefit and clinical quality arena.

CORE FUNCTIONS

1. Responsible for leading, coordinating, and developing clinical pharmacy activities and initiatives for the Managed Pharmacy Solutions (MPS) business line within Banner Pharmacy Services (BPS). Works collaboratively with MPS business partners including Banner employee benefits leaders, joint venture payer partners, various PBM teams, Banner Health Network (BHN) providers and staff, Banner Medical Group (BMG) providers and staff and BPS business line leaders to meet clinical business needs. Develop pricing and go-to-market strategies for assigned clinical services and programs.

2. Utilizing internal and external medical personnel and based on business strategy, create and maintain an outpatient-based Pharmacy & Therapeutics Committee that develops standard and custom formularies that will be applied to various Banner Health risk partners (Joint Venture, ACO and other risk-based arrangements). Creation and maintenance of policies and procedures that ensure alignment with the standards and requirements for various governing agencies (CMS, URAC, etc). Ensure that all Pharmacy & Therapeutics decisions are guided by evidence-based medicine and involves continuous review of the formulary to identify opportunities to standardize and optimize medication use.

3. Work with BPS Business Line leaders to create and maintain integrated clinical pharmacy services designed to guide prescribing to the most efficient and effective therapy based on P&T Committee recommendations, provide physicians with population and patient information regarding individual and population level medication use and suggest prescribing changes designed to achieve optimal medication therapy management. This will require leading a team of pharmacists and other healthcare professionals that report directly as well as those that do not report directly to this role.

4. Work with the leaders of the clinical pharmacy informatics program across the continuum of care to ensure the health information system supports goals of MPS and the partners served by MPS. Collaborate with key stakeholders, departments, and other individuals to improve medication use among the various health information systems and medication-related technology. This involves leveraging Cerner applications to optimize safe and appropriate medication use across the system.

5. Work directly with external vendors to ensure the correct design and set up of various clinical applications provided by Banner’s external vendor partners. This will require collaboration with external vendors on the strategy, development, construction and testing of all clinical based programs designed to support efficient medication management across provider and patient populations.

6. Function as an agent of change to design, develop, coordinate and implement programs and methods to improve medication utilization. Collect, analyze, and report information regarding the most current drug therapies. Participate in drug utilization evaluations and quality improvement processes.

7. Participate in the development of system policies, procedures, and clinical practices that pertain to medication use, medication safety, formulary management, and clinical pharmacy services. Design performance and productivity standards for all roles within assigned area of responsibility to ensure the efficient use of resources.

8. This position has a high level of complexity and provides oversight of outpatient clinical pharmacy services, creation and maintenance of an outpatient formulary and associated utilization management plan design features, and will work closely with clinical pharmacy informatics. Establishes and promotes teamwork and collaboration between individuals, departments, and the entire organization in the development of system-wide standards and targets. Primary interactions include facility and organizational leadership, physicians, pharmacists, clinical pharmacists, and other members of the Care Management team across the organization.

MINIMUM QUALIFICATIONS

Requires an advanced pharmacy degree (e.g., Pharm.D.) Requires current pharmacy or eligibility for licensure in the applicable state of practice, a degree in Pharmacy from an accredited College of Pharmacy.

Incumbents in Arizona are also required to provide the AZ Board of Pharmacy Wallet Card at time of hire.

Must have at least 5 years of clinical pharmacy experience. Must possess excellent verbal and written communication skills for interfacing with all levels of staff, physicians, and organizational leaders. Requires the ability to create collaborative working relationships. Must have a successful track record in design and implementation of new programs, services, or initiatives. Must demonstrate analytical, problem solving, project management, critical thinking, and organizational skills in a complex environment. Must have a familiarity with analytical programming and clinical systems. Must have knowledge of medication management software.

PREFERRED QUALIFICATIONS

2-3 years’ experience in a pharmacy managed care environment in a health plan or Pharmacy Benefit Management environment. Certification by the Board of Pharmacy Specialties (e.g., BCPS).

Additional related education and/or experience preferred.

EEO Statement:

EEO/Female/Minority/Disability/Veterans

Our organization supports a drug-free work environment.

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