Director, Pharmacy Services, MCC

Cambridge MA 02141 58 Charles Street

Job Description

Responsible for leading Magellan Complete Care's (MCC) efforts to develop the pharmaceutical strategy, to improve care and lower costs on the state program level. Tracks the appropriate metrics to demonstrate the quality and cost impact of all programs. Works with data management and clinical analytics to identify opportunities to improve the quality of care of pharmacy programs. Responsible for overseeing all pharmacy operations including delegated programs to ensure regulatory compliance and consistent application of benefits. Works with other pharmacy management clinical leadership to recommend, implement, and evaluate related clinical programs and services. Develops and maintains policies, procedures and processes that promote safe, efficient and cost-effective medication use in compliance with the guidelines set forth by the state, as well as all pertinent federal regulatory agencies and all accreditation bodies. Identifies staffing needs and supervises local staff. Supervises the Pharmacy Services Manager for the state office. In the absence of a Pharmacy Services Manager, MCC the Director is the primary contact for the state Medicaid program and for internal and external CMS compliance teams.
  • Provides direction and oversight for the design, implementation, and ongoing administration of prescription drug benefits for our Medicaid and DSNP members, aligned with the strategy developed by senior leadership and in compliance with Medicare and Medicaid requirements.  
  • Provides clinical pharmacy direction for their state pharmacy team including, but not limited to medical economics, disease management, pharmacy drug utilization and quality management. 
  • Assists with the development, presentation, and implementation of policies and procedures consistent with the regulatory requirements of the contracts.
  • Oversees third-party pharmacy vendors including Medication Therapy Management (MTM), Pharmacy Benefit Management (PBM), and Over-the-Counter (OTC) benefit. 
  • Monitors pharmacy utilization and produces informative reports to the state.
  • Works with the state Medical Director and medical utilization management team, and oversees pharmacy team to ensure cost effective management of both medical and pharmacy utilization.
  • Meets with the State Medicaid Regulators as required for Formulary review and required changes, program cost management, regulatory reporting, Drug Utilization reviews. 
  • May act as the POC and primary contact for state Medicaid regulators.

General Job Information

Title

Director, Pharmacy Services, MCC

Grade

31

Job Family

Pharmacy Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

5/23/2019

Date Requisition Created

5/23/2019

Minimum Qualifications

Education

Bachelors: Pharmacy (Required), PharmD: Pharmacy

License and Certifications - Required

RPH - Registered Pharmacist - Pharmacy

License and Certifications - Preferred

Other Job Requirements

Responsibilities

  • Previous experience in managed health care or Pharmacy Benefit Management environment preferred.
  • Call center experience preferred.
  • Current unrestricted state license required.
  • Demonstrated customer service and analytical skills.
  • Ability to use standard corporate software packages and corporate applications.
  • 5-7 years' pharmacy experience required.
  • 3-5 years' supervisory experience required.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

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