Associate Director Pharmacy Utilization Management

Primary City/State:

Arizona, Arizona

Department Name:

Pharm Benefits Mgmt-Misc

Work Shift:

Day

Job Category:

Pharmacy

Pharmacy careers are better at Banner Health. We are committed to developing the careers of our team members. We care about you, your career today and your future. If you’re looking to leverage your abilities – apply today. 

In this role of Associate Director Pharmacy Utilization Management, you will oversee the Pharmacists who handle Prior Authorization for Medicare and Medicaid. Experience in managed Medicaid or Medicare Advantage, and Prior Authorization is preferred. You will also be responsible for the management of the UM Pharmacists. You will ensure accurate clinical decision making and will serve as a point of escalation for difficult clinical issues. You are expected to form a dyad with the Associate Director Pharmacy Technician, who oversees the pharmacy technicians and has a more operational focus. Together with the dyad leader, you are responsible for ensuring operations meet or exceed all regulatory requirements. You must collaborate closely with other departments including Grievance and Appeals, Customer Care, Claims, and the Medical Utilization Management Teams. You will manage results and reporting results to various stakeholders including senior leaders within Banner Health.

This is a remote position working Monday - Friday within normal business hours 8M - 5PM with some flexibility. There may the need to handle issues on the weekend.

Banner Pharmacy Services is a recognized leader in healthcare and trusted partner in proactively providing innovative pharmacy services through excellence in integration, care coordination, medication management and services to make a difference in people's lives. Clinical Pharmacy Services is responsible for the management of the Banner formulary, development of standardized system wide clinical pharmacy services, and management of adverse drug event preventions. Clinical Pharmacy Services provides collaborative drug therapy management and educational interventions in patient care to optimize medication therapy, improve outcomes, promote wellness, and disease prevention. As a division, Banner Pharmacy services provides excellent patient care across our entire continuum through convenient access, improved medication outcomes and innovative pharmacy practices.

POSITION SUMMARY

This position is responsible for providing managerial and leadership support for Pharmacy’s Population Health programs and staff. Plans, directs, monitors, evaluates, and improves the provision of population-health pharmacy services; including but not limited to system and plan performance in assigned business areas. Assures adequate staffing according to workload while maintaining expected productivity levels. Develops standards of work performance, orientation and training programs. Promotes and demonstrates effective inter-disciplinary collaboration. Ensures the functions of the department are consistent with policies and procedures. Responsible for maintaining robust policies and procedures, clinical tools, and resources. Adheres to local, state, and federal laws regarding the profession of pharmacy practice.

CORE FUNCTIONS

1. Responsible for oversight of routine operations of Pharmacy Population Health Services. Provides leadership and direction to the pharmacy staff; including pharmacists and residents, pharmacy interns, pharmacy technicians, and support staff. Promotes positive relations and actively contributes to a supportive work environment. Fosters a team environment within the department and various services across the system. Participates as a pharmacy preceptor (students and residents) and, as assigned, member of the Residency Advisory Council.

2. Leads the recruitment, selection, orientation, competency assessment and evaluation of assigned employees. Serves as a change agent, role model, and facilitator for education, professional development and research. Fosters ongoing career development for assigned employees.

3. Manages assigned population health management activities; including but not limited to clinical quality programs and services, member engagement activities, provider outreach and engagement activities, utilization and medical management functions, customer service functions, data management/manipulation, and coordination with a variety of care providers, including physicians, nurses, pharmacists, care managers, and other members of the healthcare team. Operates within the budgetary guidelines of the department/system. Accountable for financial stewardship by monitoring appropriate fiscal controls and resources, equipment and supplies. Plans efficient and effective utilization of resources.

4. Participates in the development and revision of assigned programs and services and leads Quality Improvement efforts for population health pharmacy services. Leads the development, interpretation, implementation and evaluation of the goals/objectives and process improvement activities within the department. Implements decisions of the appropriate oversight committees including but not limited to Pharmacy and Therapeutics Clinical Consensus Groups related to population health. Monitors and ensures compliance with departmental and organizational policies and procedures, Federal and State laws, and regulatory agency standards. Investigates and initiates the resolution of customer complaints.

5. Serves as a professional resource in facilitating inter-disciplinary practice and communication. Provides pharmacy representation and leadership on pharmacy, system, and external committees related to population health pharmacy services.

6. Provides leadership, expectations and oversight of the member experience. Assures practitioners are providing service excellence and recovery in alignment with the organization. Participates in monitoring and quality improvement activities associated with this aspect of care.

7. Participates in the day-to-day duties of the Population Health Clinical Pharmacist and associated job duties. Time devoted to direct patient care may vary by assigned areas of responsibility.

8. This position participates in all aspects of medication use, including (1) selection, procurement and storage, (2) ordering or prescribing, (3) dispensing, (4) administering and (5) monitoring of all medications utilized. Internal customers may include Patients, Nurses, Licensed Independent Practitioners, Nursing Directors, Department Directors, Administrators and other health care team members for the purpose of integrating services, improving patient care and ensuring effective communication systems. External customers may include local, state, and national pharmacy organizations, Joint Commission, State Board of Pharmacy, colleagues and peers, educational institutions and pharmaceutical representatives.

MINIMUM QUALIFICATIONS

Doctorate in Pharmacy degree or another advanced degree in pharmacy from an accredited College of Pharmacy. Requires current pharmacy licensure in the state of practice within 90 days of hire. Completion of a PGY1 accredited pharmacy residency or equivalent clinical pharmacy experience.

Incumbents in Arizona are also required to provide the AZ Board of Pharmacy Wallet Card at time of hire.

Three years of experience within the ambulatory care, managed care, or population health management environment.

Requires demonstrated leadership ability. Requires demonstrated ability to build and maintain effective communication and working relationships with staff, physicians, patients and their families. Excellent organizational, human relations and communication skills are required to maintain good rapport and effective working relationships with internal and external customers.

Must have knowledge of computer software, Microsoft applications and electronic health records.

PREFERRED QUALIFICATIONS

Master of Business Administration (MBA). Completion of a PGY2 accredited pharmacy residency program or equivalent previous clinical pharmacy experience in Managed Care, Health-System Pharmacy Administration, or Ambulatory setting.

EEO Statement:

EEO/Female/Minority/Disability/Veterans

Our organization supports a drug-free work environment.

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