Coordinator of Pharmacy Benefits (Pharmacist) - Utilization Management - Fulltime

job
  • Henry Ford Health System
Job Summary
Location
Troy ,MI
Job Type
Contract
Visa
Any Valid Visa
Salary
PayRate
Qualification
BCA
Experience
2Years - 10Years
Posted
12 Nov 2024
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Job Description

GENERAL SUMMARY:The Pharmacy Coordinator is a licensed pharmacist that coordinates the administration of the various pharmacy program components of the Pharmacy Care Management Department by designing, implementing, maintaining and improving pharmacy benefit management programs, policies, and procedures. Major areas of responsibility may include administration of formularies, oversight of PBM systems, prior authorization systems, insuring compliance with accreditation and regulatory standards, development of new benefit designs and programs, utilization management initiatives and the management of vendor /customer relationships. This position is also responsible for educating and improving the skills of departmental staff.PRINCIPAL DUTIES AND RESPONSIBILITIES:1. Administers, designs and implements changes in both existing and new pharmacy benefit structures and processes. (e.g. benefit design, claims processing, formulary management, utilization management initiatives etc.) 2. Assures assigned daily operations are high quality and efficient and identifies opportunities for improvement. Creates monitoring, compliance and audit programs as needed.3. Assures compliance with accreditation and regulatory requirements such as NCQA, Medicare, FWA, federal & state government regulations. Supports internal and external audits as needed. 4. Develops guidelines and protocols for new drugs.5. Designs, documents and maintains policies, procedures, manuals, databases, lists, webpages and reports as assigned. 6. Coordinates the business relationship and contracts with vendors, contractors, and customers as assigned (e.g. claims processors, pharmacy networks, physician networks, employer groups, pharmaceutical companies and others.)7. Serves as an educator and resource for the pharmacy staff and others as assigned. 8. Represents the department at internal and external meetings. 9. Supports the prior authorization and appeal process as needed.10.Other duties as assigned.KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:1. Registered Pharmacist in the State of Michigan. 2. Minimum one year of managed care or pharmacy benefit management experience.3. Excellent analytical and project management skills that facilitate the efficient analysis of information and identification and implementation of improvements.4. Exemplary oral and written communication skills.