Manager Pharmacy Case Management - Remote (PA/NJ/DE)
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Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together we will achieve our mission Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together we will achieve our mission to enhance the health and well-being of the people and communities we serve.
The Manager, Pharmacy Case and Condition Management is responsible for the management of the team’s clinical and quality goals. This position reports to the Director of Case and Condition Management and is responsible for multiple aspects of operationalizing the member outreach program for Medicare Part D including oversight of a team of clinical pharmacists, pharmacy technicians and nurse health coaches for providing strategic direction for targeted STARs program initiatives, and clinical programs. The Manager is also responsible for assuring that all case and disease management activities are compliant with the standards set forth by NCQA and other applicable accrediting bodies. Serves as a liaison to internal teams for strategic planning, coordination of activities and improved customer experience.
Responsibilities:
- Provides clinical, administrative, strategic, financial and regulatory management of the Medicare Part D member outreach program , and maintaining compliance with all applicable CMS/federal Part D reporting and regulations.
- Conducts telephonic outreach to members to provide telephonic reviews of complex medication regimens, addresses barriers to access to medications and work to close gaps in care.
- Communicates directly with providers to make therapeutic recommendations and coordinate member pharmacy adherence.
- Oversees pharmacy technicians and nurse health coaches supporting Medicare Part D medication adherence and Part C gaps in care to support holistic whole person management.
- Participates and work with internal stakeholders in corporate strategic planning of Medicare Part D Service.
- Manages the recruitment, staffing and evaluation process to ensure staff competency, development and enrichment.
- Ensures that new employees follow appropriate standards and policies and works to develop associates.
- Monitors and evaluates the training and development needs of the department to ensure the optimal level of performance.
- Ensures that the case/disease management staff perform all key functions effectively and when indicated, makes recommendations for improvement.
- Acts as a resource using focused professionalism and effective interactions.
- Prepares and contributes unit specific budget data for the Director during annual budget cycles and assures unit keeps within approved yearly budget.
- Monitors all performance indicators and standards to ensure each is achieved or exceeded.
- Oversee the monthly audit process, identifying strengths and opportunities for improvement, and provides one-on-one feedback to staff promptly to ensure continuous performance improvement.
- Performs probationary, interim, and annual staff reviews and develops corrective action plans when indicated.
- Identifies individuals who exhibit a variation from standard company policy and counsels individuals in accordance with established policies.
- Builds team spirit and interdepartmental rapport, using effective problem solving and motivational strategies.
- Represents the department as a Subject Matter Expert
- Serves as alternate for internal workgroups when the Director is unable to attend or when requested.
Other duties as assigned.
Qualifications:
- Doctor of Pharmacy or Bachelor of Science Degree in Pharmacy plus 8+ years of relevant experience
- Active State Pharmacy License
- 1+ years of pharmacy experience in Managed Care focusing on clinical operations and/or formulary development/strategy/implementation preferred
- 1 year Medicare Part D experience preferred
- Self-motivated, organized, detail oriented and manages time and resources effectively. Must be able to work independently in a collaborative environment, be self-directed and possess excellent organizational and time management skills
- Excellent communication and presentation skills
- General knowledge of Microsoft Office Suite (Excel, Word, Outlook)
- Analytical thinking and excellent attention to detail
- Ability to work in a fast paced heavily regulated environment
Fully Remote:
This role is designated by Independence as fully remote. The incumbent will not be required to report to one of Independence’s physical office locations to perform the work. However, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.
Inclusion and Belonging
At IBX, everyone can feel valued, supported, and comfortable to be themselves, and all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. Celebrating and embracing diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
About Our Company
Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.
At Independence, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations. For more information about Independence access our website at www.ibx.com. We’re revolutionizing health care, and our focus is on you!
Equal Employment Opportunity
IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Agency Disclaimer
All resumes submitted directly to an Independence Blue Cross employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of Independence Blue Cross and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by Independence Blue Cross or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.