Senior Director Medicare Clinical Services

Pharmpix

8h•Onsite

About The Position

The individual will have responsibility and oversight for the development, implementation and management of the Clinical Services for PharmPix’s Medicare lines of business, including but not limited to: CMS compliant formulary development and maintenance, clinical audit procedures and client support, coverage determinations, medication therapy management and drug management programs as well as reporting (both internal and client facing) required for the activities listed on here.

Requirements

Doctor of Pharmacy Degree
Pharmacist License
At least 5 years of government programs experience, preferably on Medicare.
Thorough knowledge of CMS policies and procedures.
Expertise in Microsoft Office suite of products.
Task oriented.
Ability to focus and meet tight deadlines for client requests.
Teamwork.
Ability to think outside the box to solve client opportunities.
Effective communication skills.

Responsibilities

Support the development of a proprietary Medicare adjudication platform for PharmPix.
Support oversight of an external claims adjudication vendor.
Develop, implement and maintain CMS compliant Standard formularies for PharmPix.
Develop, implement and maintain CMS compliant custom formularies for PharmPix’s clients.
Formularies may be needed for Medicare, Medicaid or Exchange lines of business.
Develop and maintain Standard Operating Procedures that support formulary creation and maintenance.
Develop, implement and maintain a CMS compliant Medication Therapy Management (MTM) Program
Develop and maintain Standard Operating Procedures that support the MTM program.
Develop, implement and maintain a CMS compliant Drug management Program (DMP)
Develop and maintain Standard Operating Procedures that support the DMP program.
Develop, implement and maintain a CMS compliant Coverage Determination process
Develop and maintain Standard Operating Procedures that support Coverage determination management.
Develop, implement and maintain a Clinical Audit program that supports client related CMS audits and client requested mock audits.
Develop and maintain Standard Operating Procedures for the clinical audit team.
Develop a program for internal mock audits to occur year-round.
Oversight for internal and client facing reporting required for: Formulary management, Clinical Audits, MTM and DMP
Recruit, train and supervise pharmacists, pharmacy technicians and clinical coordinators in the following areas: Formulary management, Clinical Audits, MTM and DMP.
Any additional tasks required by PharmPix’s in support of client retention and growth.