Manager, Clinical Services Job in Buffalo 14201, New York US
The Manager, Clinical Services will be responsible for providing training and leadership to a team of Clinical Program Managers (CPMs) in order to optimize the clinical quality and cost-effectiveness of drug and medical therapies for health plan clients and their members. With a focus on rational management of drug utilization by employment of analytical tools and an evidence-based approach to achieve lower net cost and better health outcomes for health plans and members,this position will work within a regional account team environment to achieve team and company financial goals. This individual will manage and lead a regional team of CPMs by overseeing their hiring, training, development and mentoring in order to achieve company, client, regional account team and personal objectives. They will be responsible for the overall direction, coordination, and evaluation of the unit to include interviewing, hiring, and training employees, planning, assigning, and directing work, appraising performance, rewarding and disciplining employees, addressing complaints and resolving problems. They will also
provide clinical consultations to assigned clients that align with both the clients’ and MedImpact’s goals of lower net costs and high clinical quality. These strategic recommendations may include benefit design and formulary performance suggestions, facilitation of clinical drug information, client PT participation, recommendations for rational drug formulary positioning, on-line system edits and restrictions, on-going clinical product evaluations, and recommendations regarding client pharmacy benefit expenditures and utilization.
The successful candidate will identify and promote evidence-based intervention and communication programs with client plans. They will provide documentation of recommendations for clinically appropriate and financially beneficial clinical initiatives e.g. rebate enhancement, lower net cost, generic programs and QA initiatives. Also they will recommend and drive clinically appropriate initiatives to optimize the value of MedImpact’s rebate administration program for clients all the while delivering on the lower net cost promise. As a key player, they will need to coordinate clinical utilization analyses and presentations to client plans as well as ensure timely and accurate review of plan data according to policy. This includes preparation of an Executive Summary with appropriate intervention methodology. In addition, they will prepare, implement, and maintain DUE, DUR, and QI programs to meet plan, HEDIS, and NCQA guidelines. The Manager, Clinical Services will coordinate with the Benefits Administrator for provision of Drug Formulary and Preferred Drug Lists at the plan’s implementation and ensure compliance with Drug Formulary and Preferred Drug List, including the development of Prior Authorization criteria. This position participates in quarterly MedImpact PT Committee meetings, supports weekly FDB drug updates, and reviews, or occasionally prepares Drug Monographs.
Requirements:
For consideration candidates will need a Pharm. D from a four year college or university and (5) five to (7) seven plus years of related managed care experience, or an equivalent combination of education and job related experience. Prior supervisory experience is preferred. To perform this job successfully an individual must have knowledge of Microsoft Office Suite (Word, Excel, PowerPoint and Outlook) and a working knowledge of relational databases. This individual should have a valid Registered Pharmacist license in the State of California or an equivalent state. In addition it is preferred candidates have management and/or analytical skills with Health Informatics and experience in promoting disease management or prescription drug cost management programs.
Please visit our website at: www.medimpact.com