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Bartender ($11.30/hr)

BMC HealthNet Plan

Bartender ($11.30/hr)

Charlestown, MA +1 location
Full Time
Paid
  • Responsibilities

    Reporting to the Director of Clinical Pharmacy, the Manager of Pharmacy Services, SCO, is primarily responsible for oversight and management of the Medicare Part D clinical programs and daily operations, including initiatives that impact star ratings and ensuring compliance with regulatory requirements.  Additionally, responsibilities include assisting with pharmacy vendor and contract management, resolution of member/provider inquiries, drug utilization management, and quality improvement activities pertaining to Medicare. The SCO Manager of Pharmacy Services will interface with physicians, nurses, internal employees, PBM representatives and supervise SCO pharmacy support staff as needed.

     

    KEY FUNCTIONS/RESPONSIBILITIES:

    • Oversight and management of Medicare Part D daily operations including coverage determination activities, formulary development, program implementation and responding to member and provider inquiries.
    • Assist with oversight of the terms and conditions of each of the Plan’s pharmacy vendor contracts, including the PBM and specialty pharmacies and ensuring policies and procedures are compliant with Medicare and Medicaid requirements.
    • Implement pharmacy benefits and regulatory changes to ensure compliance with programmatic and regulatory requirements of CMS, EOHHS, and NCQA as applicable.
    • Responsible for compliance with Medicare and Medicaid regulatory reporting for the SCO program.
    • Develop, implement, and/or maintain internal policies and procedures to meet regulatory mandates and requirements.
    • Provide care management support including performing medication assessments, ensuring timely and quality consultations to care management, as well as direct member outreach for medication reconciliation needs.
    • Develop and implement clinical and strategic initiatives to achieve cost, quality and utilization objectives as well as to improve/optimize Plan’s star rating for Part D elements
    • Monitor market trends to proactively position the Plan competitively in market place.
    • Analysis of pharmacy claim data and reports to identify key drivers of cost / utilization changes and opportunities for improvement; communicate findings within the department and the health plan.
    • Facilitate internal and regulatory pharmacy audit activities.
    • Participate in interdisciplinary committees and CMS-sponsored calls as necessary to support the SCO program.
    • Maintain up to date knowledge on Medicare and Medicaid guidance as it pertains to the administration of the pharmacy benefit for the SCO program.
    • Communicate effectively with key external constituents as needed (clinics, physician group, hospital) regarding pharmacy program, formulary and pharmacy processes.
    • Hire, orient and provide supervision, performance evaluation and professional development to all clinical and operational staff for SCO.
    • Regular and reliable attendance is an essential function of the position.

     

    QUALIFICATIONS:

    EDUCATION REQUIRED:

    • Bachelor of Science in Pharmacy and appropriate state licensure.
    • Doctor of Pharmacy preferred.
    • Residency training and Board of Pharmaceutical Specialties (BPS) certification in Pharmacotherapy or Geriatrics preferred.

    EXPERIENCE REQUIRED:

    • 5+ years of clinical experience.
    • 3+ years management/supervisory experience.
    • 2+ years of prior managed care experience with Medicare Managed Care/Part D preferred.

    CERTIFICATION OR CONDITIONS OF EMPLOYMENT:

    • Current unrestricted licensure as a pharmacist in the Commonwealth of Massachusetts.

    COMPETENCIES, SKILLS, AND ATTRIBUTES:

    • Extensive knowledge of drug products, medical therapeutics, pharmacokinetics, and disease states.
    • Strong oral and written communication skills; ability to interact within all levels of the organization as well as with external contacts.
    • Demonstrated strong organization and time management skills.
    • Able to work in a fast paced environment; ability to multi-task.
    • Experience with standard Microsoft Office applications, particularly MS Outlook and MS Word, and other data entry processing applications.
    • Strong analytical and clinical problem solving skills.
    • Detail-oriented and ability to manage multiple priorities effectively.

    WORKING CONDITIONS AND PHYSICAL EFFORT:

    • Occasional travel (<5%) may be required.

     

    *Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.

    Required Skills Required Experience

  • Locations
    Charlestown, MA • Boston, MA