Senior Manager, Pharmacy Operations, Clinical Utilization & Intelligence

Job Summary:

In addition to the responsibilities listed below, this position is also responsible for leveraging an expert understanding of the drugs coming into the market and informing the organization which drugs to use; overseeing the documentation process for pharmacists to aid in the decision-making of drug administration; approving the agenda and overseeing the execution of the Pharmacist and Therapy committee, approving and adding any missing agenda items, policy creations, and guiding physicians on deciding the drugs to use within KP; proactively monitoring trends by forecasting and identifying incoming drugs within the next five years; leveraging expertise to approve pricing, usage, budgeting, and display of new drugs; partnering and providing guidance to the utilization team leaders to identify if the drugs are equally efficacious and safe; providing guidance to others on research and overseeing the review of niche drugs (i.e., limited benefit coverage and FDA coverage) to provide recommendations to physicians, promoting novel drugs to gain approval of niche drug(s) to support the physician(s) usage of the drug(s); overseeing the creation of training materials for the PGY2 Residency Program and providing guidance to residents; guiding and supporting physicians to develop guidelines to support patient care and recommendations on best practices; and overseeing the creation and review of policies and educating physicians on how best to use gene drug interactions; proactively monitoring the documentation of insights on how drug(s) are currently being used, what areas are using the drug(s), and pulling from additional data sources; overseeing education initiatives to improve drug affordability for patients within KP, ensuring drugs are high quality, safe, work efficiently and cost-effective; proactively monitoring the rollout of new drug(s), ensuring proper usage and successful implementation across KP; overseeing proper packaging of the clinical evidence summaries from the data to promote the drug(s); leading the creation of promotional content (e.g., messaging in KP Health Connect, send electronic messaging to the physicians) to introduce new drugs; overseeing the integration of new drugs once physicians review and approve them, overseeing the process of moving patients to the new cost-effective drug; and proactively monitoring areas to reduce cost through internal and external partnerships.

Essential Responsibilities:

• Creates and advocates for developmental opportunities for others; builds collaborative, cross-functional relationships. Solicits and acts on performance feedback; works with leaders and employees to set goals and provide open feedback and coaching to drive performance improvement. Pursues professional growth; hires, trains, and develops talent for growth opportunities; strategically evaluates talent for succession planning; sets performance management guidelines and expectations across teams / units. Oversees implementation, adapts, and stays up to date with organizational change, challenges, feedback, best practices, processes, and industry trends; shares best practices within and across teams. Fosters open dialogue amongst team members, engages, motivates, and promotes collaboration within and across teams; motivates teams to meet business objectives. Delegates tasks and decisions as appropriate; provides appropriate support, guidance and scope; encourages development and consideration of options in decision making; fosters access to stakeholders.
• Manages designated units or teams by translating business plans into tactical action items; oversees the completion of work assignments and identifies opportunities for improvement; ensures all policies and procedures are followed; partners with key stakeholders and business leaders to ensure products and/or services meet requirements and expectations while aligning with departmental strategies. Aligns team efforts; builds accountability for and measuring progress in achieving results; assumes responsibility for decision making; fosters direct reports to resolve escalated issues as appropriate. Communicates goals and objectives; incorporates resources, costs, and forecasts into team and unit plans; ensures matrixed resources are fulfilling service or performance requirements across reporting lines. Removes obstacles that impact performance; identifies and addresses improvement opportunities; guides performance and develops contingency plans accordingly; influences teams and units to operate in alignment with operational and business objectives.
• Oversees service area in creation of patient care strategies to pharmacy and healthcare professionals by: guiding the teams usage of analytics and informatics to track prescription use data and creating best practices and guidelines; leading in meetings of regional and/or national pharmacy and therapeutics committees to oversee support for front-line operations; and championing a patient focus mindset for others to leverage during their work at all times, and puts structures, incentives, and processes in place to encourage a patient focus.
• Guides teams engaged in a complex and comprehensive operational focus that oversees a broad set of pharmacy groupings by: leading interdisciplinary teams to implement and evaluate pharmacotherapy safety practices and initiatives; identifying and overseeing pharmacy operations initiatives and programs that directly support the day to day functioning across pharmacies and orchestrates across relevant groups on the rollout, staffing, education, etc. requirements; and overseeing a broad set of operational needs (e.g., workflow management, policy management, systems improvement, etc.), ensuring and developing policy compliance standards, and encouraging team members to identify possible process or system improvements.
• Contributes to service, affordability, people, quality of care, and regulatory pharmacy goals by: removing roadblocks and providing senior consultative support to teams to create, designing, helping to implement strategic plan to support improve service, quality, people, affordability, and regulatory initiatives; reviewing high-impact changes and establishing guidelines in alignment with established strategies to enable the support the creation of tools and dashboards to enable implementation of new programs and initiatives; modeling and ensuring team conducts sweeps of new laws and rules from regulatory agencies and ensures application into operations (e.g., FAQs to markets); evaluating and guiding innovations in new tools to ensure awareness and use in alignment with existing strategies; ensuring smooth rollout and encouraging the use of accountability dashboards; and overseeing team output and operational goals in adherence to key affordability metrics.
• Serves as the lead subject matter expert for quality improvement processes and regulations within assigned areas or teams by: providing consultation on the interpretation and interaction of current policies, and how they interact with the current climate, and potential changes to regulations and legislation; leading committees and projects to draw guidelines on improvement practice and specific improvement initiatives; reviewing multiple teams research and reports that display innovation and promise; leading interdisciplinary teams to implement and evaluate pharmacotherapy safety practices and initiatives; and identifying systematic barriers which cause issues and weighing practical, technical, and KP capability to develop corrective actions; closely collaborating with senior health care providers to gather relevant sources on potential changes within the market and upcoming new drugs and analyzes trends to forecast the impacts of new drugs on the teams drug use management; collaborating across teams and senior leaders to provide input and oversee complex pharmacotherapeutic drug regimen guidelines and trainings; developing advanced strategies to provide teams with best practices to ensure members, patients and/or healthcare providers understand appropriate use, application, and interactions of moderate to prescribed medication and proactively provides drug information to relevant healthcare providers to challenge conventional thinking; assisting in creating standards for application of strategies to ensure achievement of member financial and therapeutic objectives; and evaluating service areas reports of member data to assess overall plan outcomes and crafting recommendations and action plans on how to affect change.