Medical Benefit Clinical Program Integrity Director/PharmD required - REMOTE
Company: Prime Therapeutics
Location: Lansing
Posted on: January 24, 2023
Job Description:
Our work matters. We help people get the medicine they need to
feel better and live well. We do not lose sight of that. It fuels
our passion and drives every decision we make.Job Posting
TitleMedical Benefit Clinical Program Integrity Director/PharmD
required - REMOTEJob Description SummaryThis position is
responsible for product ownership, enhancement and improvement for
current Medical Pharmacy programs and developing, implementing,
integrating and coordinating medical pharmacy products and services
for the company across all business units as a comprehensive
solution. Responsibilities include, but are not limited to, review
of each current program functionality and results and managing end
to end process for enhancements, improvements (including
identifying deficiencies), and efficiencies, program integrity,
conceptualizing products, coordinating market research, enhancing
existing products, and integrating, implementing, and launching new
and enhanced products to increase revenues for the company.
Develops and leads a formal process to review and determine
opportunities for improvement and enhancement which may include
unique solutions for each client. Accountable to drive strategic
initiatives within the organization and is responsible for
impacting results and change often without direct line control.
Influences change and decision-making across stakeholders, both
internal and external, which is critical to the success and
achievement of desired outcomes.Job Description
- Serves as end to end product owner, responsible for program
integrity of PA, PSCE, SOS and Fee Schedule where applicable
clinically and operationally.Works collaboratively with operational
teams, (including and especially operational team product owners)
to enhance and improve current programs.
- Evaluates and designs enhancements, as well as new medical
pharmacy products and solutions. This includes utilization
management protocols (including PA and PSCE), unique pathway and
reimbursement programs, fee schedule strategies, potential site of
service opportunities, medical formularies, predictive models where
appropriate, clinical rules, and member and provider engagement
strategies across medical and pharmacy.
- Evaluates and prepares data, question sets and ideas for
internal quarterly business reviews for team discussions and
follows through on all action items, working collaboratively with
Sales Coordination Director.Provides strategic direction to the
reviews.
- Works collaboratively and in conjunction with Director,
Clinical Oncology Product Development on anything involving
oncology products or management
- Works to develop and support medical formulary initiatives
across the company for all business units.
- Develops and executes entire process for existing programs,
program integrity of current programs, and potential new products
to include but not limited to: brainstorming, data analysis
requests, action plans, implementation, contract language and
pricing, educational and client materials and program
maintenance.
- Develops and executes prototype marketing and implementation
project plans.
- Develops sample case studies and satisfaction surveys as
appropriate. Coordinates the development of new product concepts
across the organization, including analysis of market opportunity
and synergy with current operations.
- Monitors performance of existing products by conducting
analyses including, but not limited to, product performance and
savings, achievement of program goals for customers, sales and
renewals, utilization, vendor relationships, costs and margins, and
market share.
- Evaluates competitive industry data to improve the performance
of existing products or create product extensions. Develops
internal and external reports to show product performance. Develops
product improvements and enhancements.
- Serves as the product expert for internal and potentially as
needed external customers. Understands product mechanics, value
proposition, competitive position and opportunities for
enhancements and growth.
- Supports implementation of and ongoing operations including
vendor relationships, where applicable, and contracts, systems and
operational workflow development, reporting and pricing
strategies.
- Develops proposal language to describe new product capability
and conduct formal training sessions to orient organization and
communicate new product capability and launch of enhanced
features.
- Presents new and enhanced product capability to focused
prospects to test product performance against
specifications.Responsibilities
- Medical pharmacy strategy and management. Experience in either
Managed Care, Health Plan, OR PBM.
- Must have exceptional knowledge of current dynamics in medical
pharmacy and in the healthcare system, including both medical and
pharmacy operations and programs/products for Commercial, Medicare,
and Medicaid, and be able to coordinate and integrate across the
company to create a cohesive product.
- Must have significant clinical knowledge, business acumen, and
industry insight.
- In depth understanding and experience of the current medical
pharmacy market and dynamic, and any relevant current or upcoming
regulatory or legislative changes effecting medical benefit drug
management.
- Exceptional knowledge of medical and pharmacy operations,
products, and programs with strong strategic thinking and
planning.
- Prior experience and proven success in launching new products
or services to go-to-market for Commercial, Medicare and Medicare
rules and guidelines surrounding program areas of focus, and/or
Medicaid market segments.
- Proven ability to build and maintain relationships across
diverse functional teams and leaders to drive fact-based decision
making, execute with the appropriate level of urgency, and achieve
desired results.
- Ability to balance multiple accountabilities and projects, lead
and motivate people across the enterprise organization, and
effectively manage organizational changes.
- Experience in the coordination of and collaboration of work
teams and a proven track record of success while working in any of
the following functional areas: Clinical Operations, Medical
Operations, Product Management and Development, Marketing or
Account Management.
- Must possess strong organizational, project management, and
analytical skills.
- Strong verbal and written communication skills are
essential.
- Process and detail oriented with disciplined implementation
methodologies and a keen ability to execute.Work ExperienceWork
Experience - Required:Health Plans, PBM (Pharmacy Benefit
Management), Pharmacy, Product Innovation/DevelopmentWork
Experience - Preferred:EducationEducation - Required:Bachelors -
PharmacyEducation - Preferred:CertificationsCertifications -
Required:RPH - Registered Pharmacist - Pharmacy -
PharmacyCertifications - Preferred:Potential pay for this position
ranges from $117,860.00 - $200,360.00 based on location, experience
and skills.To review our Benefits, Incentives and Additional
Compensation, visit our Benefits Page
(https://www.primetherapeutics.com/careers/benefits/) and click on
the "Benefits at a glance" button for more detail.Prime
Therapeutics LLC is an Equal Opportunity Employer. We encourage
diverse candidates to apply and all qualified applicants will
receive consideration for employment without regard to race, color,
religion, sex (including pregnancy), sexual orientation, gender
identity or expression, genetic information, marital status, family
status, national origin, age, disability, veteran status, or any
other legally protected class under federal, state, or local
law.Prime Therapeutics' fast-paced and dynamic work environment is
ideal for proactively addressing the constant changes in today's
health care industry. Our employees are involved, empowered, and
rewarded for their achievements. We value new ideas and work
collaboratively to provide the highest quality of care and service
to our members.If you are looking to advance your career within a
growing, team-oriented, award-winning company, apply to Prime
Therapeutics today and start making a difference in people's
lives.Prime Therapeutics LLC is an Equal Opportunity Employer. We
encourage diverse candidates to apply and all qualified applicants
will receive consideration for employment without regard to race,
color, religion, sex, sexual orientation, gender identity, national
origin, disability, or veteran status. If you are an applicant with
a disability and need a reasonable accommodation for any part of
the employment process, please contact Human Resources at
1.866.469.1257 or email Careers@primetherapeutics.com.
Keywords: Prime Therapeutics, Lansing , Medical Benefit Clinical Program Integrity Director/PharmD required - REMOTE, Executive , Lansing, Michigan
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