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Pharmacy Manager, Managed Care and Pharmacy Contracts

Company: UT Southwestern Medical Center
Location: Dallas
Posted on: July 1, 2020

Job Description:

JOB SUMMARY
The Pharmacy Manager of Managed Care and Pharmacy Contracts is responsible for developing relationships and expanded thir party payer prescriptions programs, as well as gain access to payers for all outpatient pharmacies within the UTSW Pharmacy Serviceline. Additional responsibilities include communication and contract negotiation, medication access, pricing fees and the delivery of the Pharmacy Value Proposition. Collaborates with the Assistant Vice President of Pharmacy and Director of Pharmacy Business and Finance to help set business strategies on clinical integration of pharmacy services for population health, pharmacy sales growth, gross profit analysis and contracting payers for specialty, home infusion and other ambulatory pharmacy services.

EXPERIENCE and EDUCATION

  • Required: Bachelor s degree in Business Administration or related field and six (6) years of directly related experience with three (3) years in managed care/payer contracting.
  • Preferred: Master s degree in Business or Healthcare Administration and eight (8) years directly related experience with four (4) years in managed care/payer contracting. JOB DUTIES
  • Demonstrate continuous performance improvement in targeted areas of responsibility in alignment with the overall annual UTSWMC performance improvement targets.
  • Meets or exceeds financial goals and objectives of the Pharmacy Serviceline.
  • Extensive knowledge of retail, specialty and pharmaceutical-related products and services, including ambulatory pharmacy services, specialty pharmacy, Pharma relationships and other pharmacy related population health opportunities.
  • Oversees financial, operational and delivery aspects of pharmacy payer contracts including performing quarterly business reviews with contracted plans by monitoring contract consistency and compliance. Develop, recommend annual third party payer negotiation parameters and execute negotiations consistent with budget.
  • Serves as the operations resource and participate in strategic discussions surrounding potential clients, payer strategies and contracting strategies while complying with legal and regulatory requirements.
  • In conjunction with overall UTSW health system strategic plan, facilitates ambulatory pharmacy new business growth/development including payer negotiation, implementation of new contracts, monitoring of financial indicators and modification of business strategy to sustain profitability of separate business lines.
  • Interface with accounting departments to identify and give direction in managing reimbursement/collections issues for pharmacy enterprise. Provide strategy in the development of reporting capabilities that can identify opportunities to increase collection rates.
  • Leads development of billing structure and reimbursement policies for ambulatory pharmacy services.
  • Collaborates with AVP of Pharmacy, Director of Pharmacy Business and Finance and Director of Ambulatory Pharmacy to develop and execute the national/regional/local business plans and assists with writing a business plan by including the health plan targets for the upcoming quarter and year. Develop pharmacy services for population health to increase value based services and reimbursement for MTM clinics.
  • Develops and manages the analytics tools and reports needed to fully understand the business factors of the Pharmacy Serviceline.
  • Oversee Pharma trade relationships to contract, negotiate and get access for all medications, including specialty, inpatient and retail pharmacy products.
  • Utilize pharmacy operations expertise on third party plans to analyze opportunities and develop pharmacy programs to improve therapeutic outcomes, reduce overall pharmacy cost and enhance quality program initiatives.
  • Supports and partners with the Chief Financial Officer on hospital and health system goals and other administrative and financial issues.
  • Leads Change - Takes initiative; shows adaptability, flexibility; thinks and plans strategically; articulates clear vision and goals; champions innovation.
  • Drives for Results - Manages business operations effectively; effective follow-though and follow-up; takes accountability; solves problems and implements solutions; integrates financial understanding into solutions; demonstrates technical proficiency.
  • Building Teams - Clarifies roles and responsibilities; includes all organization personnel into decision making process; develops win-win solutions; collaborates with colleagues and peers; builds coalitions and partnerships; manages conflict constructively.
  • Focuses on Customer - Acts with urgency to address service issues; assesses and anticipates customer needs; demands highest level of service from self and staff; recovers quickly from service breakdowns and improves processes; ensures staff technical training and proficiency.
  • Communicates - Encourages candid exchange of ideas; articulates views clearly and directly; expresses facts clearly in writing; listens attentively to others; communicates a compelling vision to staff; communicates quickly issues affecting staff.
  • Displays friendliness, compassion, sensitivity, kindness and appropriate manners in interactions with patients, physicians and other ancillary healthcare staff
  • Displays open-mindedness and objectivity in relations with patients, physicians, and other ancillary healthcare staff
  • Promotes a spirit of unity which enables the group to work together to achieve a common goal
  • Takes initiative to perform job and/or assist co-workers, supporting the work of others in accomplishing the mission
  • Displays adaptability by adjusting to meet the needs
  • Receives suggestions in a positive manner for improvement and necessary changes in scheduling, procedures and assignments
  • Exhibits behaviors, which demonstrate competence, reliability, self-control, honesty, and appropriate overall appearance while rendering service
  • Ensures qualified clinicians are accountable to the organization
  • Performs other duties as assigned.

    WORKING CONDITIONS
    Work is performed primarily in pharmacy and office environments.



    SECURITY
    This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information

    SALARY
    Salary Negotiable

    ***Any qualifications to be considered as equivalents in lieu of stated minimum require prior approval of Vice President for Human Resources Administration or his/her designee.

    UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. In accordance with federal and state law, the University prohibits unlawful discrimination, including harassment, on the basis of: race; color; religion; national origin; sex; including sexual harassment; age; disability; genetic information; citizenship status; and protected veteran status. In addition, it is UT Southwestern policy to prohibit discrimination on the basis of sexual orientation, gender identity, or gender expression.

    Associated topics: dietary, disease, drug discovery, industrial hygienist, kinesiology, metabolism, nephrology, pharmacometrics, protein, virus

Keywords: UT Southwestern Medical Center, Dallas , Pharmacy Manager, Managed Care and Pharmacy Contracts, Healthcare , Dallas, Texas

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