Summary

The Director, Pharmacy Network Administration develops and promotes the overall vision, goals, objectives and strategies for assigned work groups in line with overall organization strategic priorities. Directs the staff, assets, processes, and work activities of assigned work groups to ensure the highest quality service levels are maintained and business unit goals are aligned, and all strategy is in compliance with all legal, Federal and State regulations, as with the strategic direction of corporate initiatives. Develops and executes plans to achieve client, pharmacy and customer commitments. Relies upon extensive experience, judgment, business & systems knowledge, and technical skill to plan and accomplish goals.

This position will partner with all key internal stakeholders including but not limited to Finance, Underwriting, Legal, Marketing, Implementation/Service Delivery, Account Management and Sales to achieve revenue targets, ensure account profitability, execute client commitments flawlessly, and build sustainable strategic alliances with pharmacy chains and associations, as well as, new clients in the MCO and Self-Insured segments.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Responsible for pharmacy network profitability and providing high quality, comprehensive pharmacy network management services to book of business consisting of specified pharmacy chains or provider type, including maintaining the appropriate access, mix and geographical distribution of network providers for Retail, Long Term Care, Mail Order, Specialty, Home Infusion, and/or Indian Tribe networks;
• Partners with client teams and internal and external stakeholders to develop network strategies to achieve growth plans, rate requirements, access standards, and network performance commitments;
• Collaborates with Pharmacy Network Strategy and Network Operations Management staff to implement new networks, enhance existing networks, and evaluate network performance & alignment with business objectives;

• Responsible for researching and resolving complex client network issues, including rate discrepancies and conflicts between pharmacy relationships and business needs. Cultivates effective relationships with pharmacy provider representatives, client representatives and internal stakeholders, including adherence to agreed-upon rules of engagement and roles & responsibilities;
• Makes sure that Department adheres to strict procedural and quality standards, including thorough and accurate documentation, testing protocols, and claims analysis, as well as, compliance to all Federal (ie, Medicare/CMS) and State Laws (Medicaid, Any Willing Provider, MAC Management);
• Stays abreast of CMS Medicare and State Medicaid requirements as they apply to pharmacy networks. Acts as pharmacy network SME in reviewing new guidance and determining changes required to systems and policies and procedures in order for MedImpact to remain compliant. Partners with internal Legal and Compliance staff as needed in interpreting regulations. Participates in industry forums and work groups to ensure consistency with the industry processes;
• Directs Pharmacy Network Management team members in managing relationships with assigned pharmacy partners, including compliance with contract and regulatory requirements, supporting unique needs and business requirements, and driving toward MedImpact’s strategic network objectives;
• Advises Sales staff on network options and opportunities that optimize revenue and match client business objectives;
• Provides direction to partner with Business Development and Implementation staff to ensure that new client network needs are appropriately met. Documents and communicates network requirements to Pharmacy Network staff to ensure accurate solicitations and timely network development. Ensures that new client networks conform to commitments at go live;
• Partners with client teams to ensure that client network performance obligations are achieved and maintained, including strategic growth plans, pay for performance arrangements, and network rate requirements;
•  Creates and deploys client specific network diversification plans for Department to minimize risk, leverage competition among providers, and maintain flexible and scalable network offerings;
• Directs department to manage and execute Company’s products and services including but not limited to 340B, Choice Specialty, Compounding, Performance Network products, Flu and Vaccine product, mail and specialty PG management;
• Appropriately & accurately documents network information, issues, projects, and projects, and work requests. Oversees assigned cases and ensures adherence to due dates;
• Provides direction in order to recruit, manage and retain the necessary resources to successfully perform the duties of the assigned Operations work groups. Develops staff to meet the current and future needs of the organization. Models and cultivates staff behaviors that achieve business success, including leadership skills, collaboration, accountability, and ownership. Ensures that staff members are aware of business plan objectives, individual accountabilities, and the competencies critical to successful job performance;
• Directs work groups to achieve service commitments, including sustainable, measurable, accurate, reliable, and timely execution of project deliverables. Provides day-to-day leadership and direction, including developing and administering policies, business processes, quality standards, measurement criteria, and operating budgets. Directs improvement opportunities. Sets high standards and encourage new ideas for improving organizational performance;
• Partners with other MedImpact business units to effectively resolve customer issues and inquiries, implement new business, design solutions that meet the mutual needs of MedImpact and our customers. Promptly responds to service failures, resolves issues, and escalates concerns as appropriate. Supports new product offerings and strategic marketing efforts. Actively participates as a key member of cross functional workgroups, teams, and committees as assigned;
• Aligns direction of assigned work groups with enterprise strategy. Champions the organization’s position in relation to industry and market trends. Executes strategically to ensure the delivery of flawless service and quality as a competitive differentiator in the PBM market place.

Supervisory Responsibilities        

Manages assigned staff in the segment area. Responsible for the overall direction, coordination, and evaluation of the unit. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems. Supports and enforces all company policies and procedures in a fair and consistent manner, taking corrective action whenever necessary.

Client Responsibilities

This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written).  One must be able to; manage difficult or emotional client situations; Respond promptly to client needs; Solicit client feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

BA/BS Degree or equivalent; plus 10 years’ related experience; 10 years of SME in respective area(s); (or equivalent combination of education and experience); and 8 years supervisory experience; Supervisory experience may be substituted with 10 years of MedImpact experience plus an appropriate external leadership training program and internal mentorship with a seasoned leader at the Director level or above that must be  completed within 12 months in new position. 

Computer Skills

Experienced in Microsoft Office Suite word processing software, Excell.  SQL and Access Data Base highly desired.

Certificates, Licenses, Registrations

Proven Leadership Courses, PMP Certification, or other highly desirable.

Other Skills and Abilities

• Candidate must demonstrate strong leadership skills and be able to lead diverse teams. Extensive knowledge of PBM or Healthcare industry. Proficient with personal computers and MS Office. Strong project management, financial acumen, quantitative, analytical, verbal and written communication skills. Candidate must be detail oriented, organized and have a sense of urgency to meet deadlines and the ability to direct and manage multiple concurrent priorities.

Reasoning Ability

• Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.  Ability to deal with problems involving several concrete variables in standardized situations.

• Ability to define problems, collect data, establish facts, and draw valid conclusions.

Mathematical Skills

• Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. 

• Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.

Language Skills    

• Ability to read, analyze, and interpret the most complex documents.   

• Ability to write routine reports and correspondence.  Ability to speak effectively before groups of customers or employees of organization.

• Verbal Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.
• Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.

Competencies To perform the job successfully, an individual should demonstrate the following competencies: