Henry Ford Health System Manager - Pharmacy Benefits - HAP Midwest - Southfield in Southfield, Michigan
GENERAL SUMMARY: The Manager of Pharmacy Benefits for Midwest Health Plan is a licensed pharmacist that has leadership and operational responsibility for all components of the Midwest Health Plan Medicaid and Medicare pharmacy programs. Major areas of responsibility include PBM oversight, plan benefit implementation, formulary management, coverage determinations and appeals. Implementation of best practices is critical in order to achieve compliance with all regulatory requirements, maximum accreditation scores and superior quality rankings. PRINCIPLE DUTIES AND RESPONSIBILITIES: Works with the contracted pharmacy benefit management company to assure accurate, timely and high quality implementation of pharmacy benefits. Operationalizes and oversees the coverage determination and appeal process so that all compliance standards and timelines are met. Oversees formulary development and implementation to assure compliant and cost-effective formulary management. Manages Pharmacy &Therapeutic Committee process. Reviews CMS, federal and state regulations/guidance along with NCQA accreditation standards to assure departmental processes and procedures are updated as needed to result in efficient and compliant administration of the pharmacy programs. Oversees related audit activities and corrective action plans.Works with other disciplines such as physicians, nurses and case managers as needed to improve care of members. Provides supervision and leadership for assigned team members in order to achieve both departmental goals and professional growth of the individual team members.Other duties as assigned
EXPERIENCE / EDUCATION REQUIRED:Advanced clinical pharmacy skills as evidenced by a doctor of pharmacy degree or equivalent experience. Licensed to practice pharmacy in Michigan. Minimum 1 year of experience in pharmacy benefit management Strong leadership skills which enables the candidate to lead work groups effectively. Exemplary oral and written communication skills as evidence by prior examples of effective implementation of strategies with a variety of system personnel and patients. Consistently Displays the HFHS Leadership Standards of Excellence:Listens and Communicates EffectivelyCoaches and Mentors OthersMotivates and Inspires OthersHas the Courage to InnovateIs Accessible to OthersRewards and Recognizes the Accomplishments of OthersIs Accountable for Achieving Desired ResultsOverview Henry Ford Health System, one of the largest and most comprehensive integrated U.S. health care systems, is a national leader in clinical care, research and education. The system includes the 1,200-member Henry Ford Medical Group, five hospitals, Health Alliance Plan (a health insurance and wellness company), Henry Ford Physician Network, a 150-site ambulatory network and many other health-related entities throughout southeast Michigan, providing a full continuum of care. In 2015, Henry Ford provided $299 million in uncompensated care. The health system also is a major economic driver in Michigan and employs more than 24,600 employees. Henry Ford is a 2011Malcolm Baldrige National Quality Award recipient. The health system is led by President and CEO Wright Lassiter III. To learn more, visitHenryFord.com. Benefits Whether it's offering a new medical option, helping you make healthier lifestyle choices or making the employee enrollment selection experience easier, it's all about choice. Henry Ford Health System has a new approach for its employee benefits program - My Choice Rewards. My Choice Rewards is a program as diverse as the people it serves. There are dozens of options for all of our employees including compensation, benefits, work/life balance and learning - options that enhance your career and add value to your personal life. As an employee you are provided access to Retirement Programs, an Employee Assistance Program (Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness and access to day care services at Bright Horizons Midtown Detroit, and a whole host of other benefits and services. Equal Employment Opportunity/Affirmative Action Employer Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System is committed to the hiring, advancement and fair treatment of all individuals without regard to race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height, weight, marital status, family status, gender identity, sexual orientation, and genetic information, or any other protected status in accordance with applicable federal and state laws.