Blue Cross Blue Shield of Massachusetts Pharmacy Provider Partnership Manager in Hingham, Massachusetts
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Under the leadership of the Senior Director, the Pharmacy Provider Partnership Manager is responsible for the communication, coordination and assessment of clinical pharmacy programs that support BCBSMA prescribers including the Alternative Quality Contract (ACQ) provider groups. The primary functions will be to develop actionable pharmacy strategies that are both clinically appropriate and cost effective and help address provider point of prescribing decision making as well as identifying prescriber practice variations.
SUMMARY OF RESPONSIBILITIES AND KEY RESULTS:
Serves as the primary clinical pharmacy program contact and subject matter expert to ACQ providers, network providers and internal teams regarding clinical intervention programs and pharmacy benefit management issues
Provides clinical direction/expertise to data analysts to create prescription drug reports that will help identify opportunities to improve quality and cost-effective use of drugs and identify prescriber pattern variation.
Monitors program data and metrics to evaluate effectiveness and clinical outcomes, and makes recommendations for targeted improvement strategies.
Partners with Clinical Pharmacy to develop new clinical intervention strategies and programs related to drug utilization management to improve quality and cost effectiveness to support the AQC groups and network providers.
Track specialty and non-specialty drug pipeline activity to proactively identify clinical management opportunities for provider impact when product become available on market
Collaborate with PBM and other internal/external partners to evaluate programs after implementation to ensure objectives are met.
Provide clinical support for Pharmacy metrics/goals related to quality improvement programs (e.g. NCQA, HEDIS)
Provide clinical expertise to other Pharmacy programs and initiatives including but not limited to specialty pharmacy networks and account support.
Supervise direct reports to establish measurable individual performance goals. Monitor progress toward achievement and recognition of goals on a regular basis and take corrective action when necessary.
Balance corporate and pharmacy program objectives with member/account/provider initiatives, including support of BCBSMA consumer engagement strategies.
Represent area as a subject matter expert to other areas within Blue Cross Blue Shield of Massachusetts
Special projects as assigned
EDUCATION AND EXPERIENCE REQUIREMENTS:
Minimum of professional Registered Pharmacist degree required. Graduate study in a business, public health, or health policy field will be favorably considered.
Unrestricted current and valid license to practice pharmacy in the state of Massachusetts
5-7 years of pharmacy practice required
3-5 years prior pharmacy management experience preferred
Experience in direct supervision of technical support staff for clinical and/or service and operational programs is desirable.
Experience in a managed care setting, either from the provider, the payer, or the PBM side of the industry, is required.
Proficiency in standard computational office-suite applications, including word-processing and relational database manipulation is required.
SKILL AND BEHAVIORAL COMPETENCIES REQUIRED:
Excellent written and oral communication skills including ability to present to senior leaders
Excellent interpersonal skills
Strong organizational and time management skills, including ability to work independently and prioritize multiple projects and assignments
Demonstrated strength in analysis, identification of problems and issue resolution
Excellent skills in teamwork and team approaches to goal setting and attainment
Demonstrated ability to establish and maintain positive, effective working relationships with staff, internal and external customers
Must be results oriented
LocationHinghamTime TypeFull time
Voted as the highest in member satisfaction among Massachusetts commercial health plans by JD Power, Blue Cross Blue Shield of Massachusetts is a community-focused, tax-paying, not-for-profit health plan headquartered in Boston. We have been a market leader for over 75 years, and are consistently ranked among the nation's best health plans. Our daily efforts are dedicated to effectively serving our 2.8 million members, and consistently offering security, stability, and peace of mind to both our members and associates.
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We are committed to investing in your development and providing the necessary resources to enable your success. We are dedicated to creating a refreshing and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path. We take pride in our diverse, community-centric, wellness-focused culture and believe every member of our team deserves to enjoy a positive work-life balance.
Blue Cross Blue Shield of Massachusetts is an Equal Employment / Affirmative Action Employer. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or expression, or any other characteristics protected by law.
Blue Cross Blue Shield of Massachusetts will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with Blue Cross Blue Shield of Massachusetts's legal duty to furnish information.