VP Pharmacy Services

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Position Summary

The Vice President of Pharmacy Services provides strategic leadership and oversight for all pharmacy operations within the organization and for all bid related formularies/ strategies for market competitiveness and value. The Vice President is also responsible for the management of the PBM and other pharmacy related vendors as well as the Mail Order Pharmacy for USFHP. The Vice President will be responsible for ensuring PBM contract compliance and rebate optimization, ensuring full CMS and USFHP compliance. They will also ensure optimal STARS and HEDIS performance with respect to Medication Adherence, analysis of population clinical data, and retail and specialty pharmacy spending for optimal clinical and fiscal management. This person will be a member of the Senior Leadership team and manage Medicare Advantage and USFHP pharmacy related programs, collaborating within the enterprise on pharmaceutical expense management, quality/utilization management and health plan/ practice operations.

Job Description

PRIMARY DUTIES AND RESPONSIBILITIES

• Provides strategic and operational leadership for the Pharmacy division to achieve organizational goals related to financial performance, sustainability, growth, and pharmaceutical management targets established through the strategic planning and budgeting processes.

• Directs the full scope of pharmacy operations, including formulary management, prior authorizations, formulary exceptions, medication adherence, patient accounting, billing practices, vendor billing oversight, and daily systems operations to ensure efficient, effective, and high-quality service delivery.

• Ensures Pharmacy division readiness for payer, regulatory, contractual, and accreditation requirements, including preparation for the CMS MA bid process and compliance with all applicable vendor, payer, federal, state, and accreditation standards.

• Establishes and oversees pharmacy performance metrics, data analysis, and quality improvement initiatives to evaluate divisional performance, improve patient care outcomes, strengthen contracted performance, and identify opportunities for operational and strategic process improvement.

• Ensures all pharmacy related policies are clinically sound with EBM criteria and have appropriate UM management activities, such as step therapy, for appropriate fiscal management.

• Partners collaboratively across Pharmacy, Finance, Nursing, Medicine, Population Health, Practice, and other MPHC divisions to align clinical, administrative, and business processes, support patient-centered care, and promote appropriate prescribing, documentation, coding, reconciliation, and reimbursement practices.

• Provides leadership for pharmacy technology, systems optimization, and workforce planning, including technology assessment, software testing and implementation, operational system enhancements, staffing model development, and recruitment planning in partnership with Human Resources.

• Serves as the primary representative and spokesperson for the Pharmacy division, building effective internal and external relationships and advancing high levels of satisfaction among patients, members, providers, and other stakeholders across the continuum of pharmacy services.

• Provides timely guidance regarding pharmacy market trends, legislative and regulatory developments, and consultant deliverables to inform strategic decision-making across the organization

POSITION QUALIFICATIONS

Education:

• BS Pharmacy or PharmD required

• PharmD, MBA preferred

Licensure/certification:

• Must possess Maine and New Hampshire pharmacy license (or eligible)

Experience:

• 10 years' experience including managed care experience (i.e., PBM, HMO, group practice) and retail pharmacy experience (i.e., chain, independent, mail order)

• Experience leading complex cross-functional projects and implementations

• Experience with pharmacy vendor management, contract oversight, and review of key contractual elements

• Experience supporting Medicare bid development, formulary strategy, or pharmacy financial analysis

• Experience evaluating pharmacy programs and policies from both clinical and financial perspectives

• Experience reviewing financial reports, reconciliations, invoices, and pharmacy trend data

Knowledge:

• Effective team leader/builder

• Excellent leadership qualities

• Mentor and coach

• Strategic thinker and problem solver with an eye for continual process improvement

• Strong knowledge of Medicare Part D regulations and the Medicare annual bid process

• Knowledge of pharmacy benefit design, formulary strategy, PBM operations, and pharmacy claims administration

• Knowledge of pharmacy financial drivers, trend analysis, forecasting inputs, and invoice reconciliation processes

• Knowledge of federal and state laws and regulations and applicable accreditation standards

• Ability to evaluate pharmacy policies and initiatives using both clinical and financial business judgment

• Strong understanding of drug pipeline trends and factors affecting pharmacy cost and utilization

Skills:

• Excellent oral and written communication skills

• Excellent interpersonal skills

• Excellent delegation skills

Abilities:

• Ability to be a critical thinker

• Ability to establish accountability

• Ability to design work processes around customer needs and expectations

• Ability to prioritize

This position is not eligible for immigration sponsorship.

We are an equal opportunity/affirmative action employer.

Martin's Point complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact jobinquiries@martinspoint.org

Do you have a question about careers at Martin's Point Health Care? Contact us at: jobinquiries@martinspoint.org