Director of Pharmacy Benefits (Healthcare)

Title: Director of Pharmacy Benefits
Reports to: Chief Pharmacy Officer
Classification: Director
Location: Boston (Hybrid)
Job description revision number and date: V2.0; 12.02.2024

Organization Summary:
Community Care Cooperative (C3) is a 501(c)(3) non-profit, Accountable Care Organization (ACO) governed by Federally Qualified Health Centers (FQHCs). Our mission is to leverage the collective strengths of FQHCs to improve the health and wellness of the people we serve. We are a fast-growing organization founded in 2016 with 9 health centers and now serving hundreds of thousands of beneficiaries who receive primary care at health centers and independent practices across Massachusetts. We are an innovative organization developing new partnerships and programs to improve the health of members and communities, and to strengthen our health center partners.
Job Summary:
The Director of Pharmacy Benefits will be part of the subsidiary, C3 SCO/One Care, LLC, and report to the Chief Pharmacy Officer. The Director of Pharmacy Benefits is responsible for the strategic oversight and management of the pharmacy benefit program for our SCO/One Care programs, ensuring optimal performance, and cost-effectiveness, and overall compliance with strict Medicare Part D and MassHealth regulations. This role involves direct supervision of the Pharmacy Benefit Manager (PBM) and collaboration with various stakeholders to enhance the quality and efficiency of pharmacy services.

Responsibilities:
Develop and implement strategic plans for the pharmacy benefit program Oversee the performance and operations of the Pharmacy Benefit Manager (PBM) Ensure compliance with all regulatory requirements and industry standards, including compliance with Medicare Part D and MassHealth regulations and timelines Reports to the leadership team as necessary Ensure pharmacy adequate pharmacy network Manage the pharmacy benefit budget, ensuring cost-effective use of resources Analyze financial reports and data to identify cost-saving opportunities Negotiate contracts with PBMs and other vendors to secure favorable terms Monitor and evaluate the quality of pharmacy services provided Implement quality improvement initiatives to enhance patient outcomes Ensure the PBM adheres to established performance metrics and standards Ensure member and provider satisfaction in relation to pharmacy Ensure adequate support and improvements required for achieving adequate Medicare Star Ratings Work closely with healthcare providers, insurers, and other stakeholders on meeting strategic and compliance objectives and timelines, providing support, and education as necessary Collaborate to ensure member satisfaction Facilitate communication and coordination between the PBM and other departments Provide oversight for pharmacy prior authorization completed by PBM partner and appeal processes as well as support the member grievance investigation and resolution related to pharmacy issues Develop and update policies and procedures related to pharmacy benefits Ensure policies are aligned with organizational goals and regulatory requirements Educate staff and stakeholders on policy changes and updates Utilize data analytics to assess the effectiveness of the pharmacy benefit program Prepare and present reports on program performance to senior management Identify trends and make recommendations for program improvements and development Other projects and duties as assigned
Required Skills:
Minimum of 7-10 years of experience in pharmacy benefits management, with at least 5 years in a leadership role, and Medicare Part D management Leadership and team management Strong analytical and problem-solving skills Excellent communication and interpersonal abilities Financial acumen and proven ability to manage budgets and negotiate contracts In-depth knowledge of pharmacy benefit management and healthcare regulations Strategic thinking and planning Quality and performance management Stakeholder engagement and relationship building Must be able to remain in a stationary position 50-75% of the time
Desired Other Skills:
Familiarity with the SCO/One Care programs Familiarity with the MassHealth ACO program Familiarity with Federally Qualified Health Centers Experience with anti-racism activities, and/or lived experience with racism is highly preferred Qualifications: Advanced degree (PharmD, MBA, MHA) preferred RPh in good standing in Massachusetts required
** In compliance with Covid-19 Infection Control practices per Mass.gov recommendations, we require all employees to be vaccinated consistent with applicable law. **