Position Summary

The Director of Clinical Operations and Product Development manages the activities and performance of internally facing clinical pharmacists in the areas of prior authorization review, formulary management, utilization management, and other clinical programs. The Director of Clinical Operations and Product Development also leads the development and implementation of new clinical programs and ensures compliance with corporate, contractual, and departmental requirements.

Essential Functions And Responsibilities

This list of duties and responsibilities is not all inclusive and may be expanded to include other duties and responsibilities as management may deem necessary from time to time.

• Oversee clinical operations pharmacist staff and functions, including hiring, onboarding, training, performance management, and departmental policies, procedures, and performance.
• Manage the departmental budget in coordination with leadership, ensuring cost containment and appropriate expense management.
• Work closely with leadership to develop and execute the clinical operations strategy, including accountability for key performance indicators and other productivity and quality measures.
• Lead product development of pharmacy benefit management (PBM) clinical pharmacy products, services, and initiatives, including coordination of work and timely delivery of cross functional deliverables.
• Oversee effectiveness monitoring of utilization management programs including annual review of criteria, and cross-departmental collaboration on outcomes reporting.
• Manage relationships with outside vendors and monitor for compliance with contractual requirements and/or performance guarantees.
• Oversee development of pertinent training, documentation, and communications.
• Lead root cause analysis and resolution of reported quality concerns.
• Know and comply with company policies, regulations such as HIPAA, and adhere to the highest ethical standards.
• Perform other duties as assigned.
  
  

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education And Experience

• PharmD degree from an accredited School of Pharmacy preferred.
• Minimum 8 years of experience working with PBM operations, or any combination of education and experience, which would provide an equivalent background.
• Previous experience managing employees.
• Experience in prior authorizations.
• MS Office Professional Experience.
  
  

Required Credentials / Licensing / Certification

• An active and current pharmacist license in the home state of residency that is in good standing and has no restrictions.
• Maintain a valid driver’s license and personal insurance liability coverage, as required.
  
  

Competencies

• Proficient with MS Professional.
• Advanced knowledge of managed care and pharmacy benefit management practices, including utilization management.
• Advanced critical thinking, problem solving, and decision making. Uses sound judgment and common sense to make competent, timely and effective decisions. Demonstrated ability to identify root causes and recommend process improvements and/or solutions.
• Advanced verbal and written communication skills.
• Strong time management and organizational skills to include managing within budgets to meet department objectives.
• Demonstrated ability to attract and retain talent, lead and motivate teams for high performance, develop, mentor, and coach staff, and influence people to get results through others.
• Demonstrated ability to plan and manage complex and successful projects; understand available resources, develop timeline, budget and assign areas of responsibility.
• Proven ability to proactively build and align stakeholders, capabilities, and resources across departments in order to get things done quickly and achieve complex objectives.
• Advanced understanding of the laws, rules, regulations and standards governing PBM.
  
  

Physical Demands

• Occasionally lifts/pulls/carries up to 25 pounds.
• Frequently required to stand, sit, talk and hear, and use hands to handle, or touch objects or controls.
• On occasion the incumbent may be required to stoop, bend, kneel, or reach above the shoulders.
• Operate typical office equipment such as a computer, telephone, copy machine, etc.
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
• Regular mental demands such as comprehension, reasoning, decision making, and strong math skills.
  
  

The mental and physical requirements described here are representative of those that must be met by an individual to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Working Environment

• Continuous work in an office setting with moderate noise exposure.
  
  

The work environment characteristics described here are representative of those an individual encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The above statements reflect the general details necessary to describe the principle functions of the occupation described and shall not be construed as a detailed description of all the work requirements that may be inherent in the occupation.