Pharmacy Manager, Managed Care and Pharmacy Contracts
Company: UT Southwestern Medical Center
Posted on: July 1, 2020
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
- 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
- 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
- Serves as the operations resource and participate in strategic
discussions surrounding potential clients, payer strategies and
contracting strategies while complying with legal and regulatory
- 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
- 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
- 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
- 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
- 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
- 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
- Ensures qualified clinicians are accountable to the
- Performs other duties as assigned.
Work is performed primarily in pharmacy and office
This position is security-sensitive and subject to Texas Education
Code 51.215, which authorizes UT Southwestern to obtain criminal
history record information
***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
Associated topics: dietary, disease, drug discovery, industrial
hygienist, kinesiology, metabolism, nephrology, pharmacometrics,
Keywords: UT Southwestern Medical Center, Dallas , Pharmacy Manager, Managed Care and Pharmacy Contracts, Healthcare , Dallas, Texas
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