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Position Description

Arkansas Blue Cross and Blue Shield - EXEMPT POSITION DESCRIPTION

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Position:  Pharmacy Director
Reports To: 
Division:  Enterprise Pharmacy Prgms (0085)
Company:  ABCBS
Location:  Little Rock - USAble Building
Job Code:  015234
Min Salary:   85500
Date:  8/15/2012

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Position Specific Requirements: N/A


Job Summary
The Director reports to the Vice President of Enterprise Networks. This position provides leadership to all pharmacy management staff primarily through the Clinical Director, the Associate Director and the Operations Manager.

Key responsibilities include the efficient and effective operation of Enterprise Pharmacy Programs including oversight of vendor contracts and services, eligibility, claims, customer service, clinical services, rebating, pharmacy network contracting, Retire Drug Subsidy, CMS contracting and compliance. This position is also responsible for the planning and budgeting for the pharmacy department.

The Director of Enterprise Pharmacy Programs is responsible for strategic planning and development of a competitive, well managed, and cost effective pharmacy program for Arkansas Blue Cross and Blue Shield, Health Advantage, Blue Advantage Administrators, USAble Life, and USAble Administrators. The pharmacy department is responsible for both commercial business as well as the Medicare D program.

The incumbent must possess competencies to develop effective solutions to issues and problems in all areas of responsibility. Additionally, the incumbent must be able to organize, build and direct a qualified and competent staff to sustain an effective pharmacy program.

The incumbent must be experienced in establishing and maintaining positive working relationships with the Arkansas Pharmacy Association, pharmacists, CMS, providers, community leaders/organizations, enrolled and prospective employer groups.

Nature & Scope
The Director regularly interacts with senior management, regional executives, medical directors, sales and operation staffs, clients and members of the provider community. This position establishes management structures and programs necessary for the success and profitability of the business, the growth of current products and markets, and the identification/diversification into new products and markets. This position functions as a professional member of various enterprise committees and task forces established to sustain and enhance the overall position of the enterprise in the market place.

This position is responsible for managing internal pharmacy staff (clinical services, prior authorization, claims, web, customer service, pharmacy network, administrative contacts, Medicare D programs), as well as external partners and multiple vendors.

Minimum Job Requirements

1. Bachelor's degree.

2. A degree in pharmacy from an accredited college of pharmacy

3. Licensed to practice pharmacy in the state of Arkansas

4. Experience at the management level.

5. Experience in health insurance industry at the exempt level

6. Pharmacy or related healthcare management experience.

7. Professional designation related to the insurance, managed care or healthcare industries.

8. Strong verbal and written communication skills, presentation skills, organizational skills, analytical skills, problem solving skills, decision-making skills and strong people skills.

9. Demonstrates stability of performance under pressure and/or opposition.

10. Experience in managing Pharmacy Benefits Managers (PBM).

11. Pharmacy operations experience including claims processing, customer service, prior authorization, reporting, benefit design and set up.

12. Experience with Medicare D- Prescription Drug Programs (PDP).


Security Requirements
This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.

Segregation of Duties
Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.

PRINCIPAL ACTIVITIES OR ACCOUNTABILITIES (Essential Functions of Job)
1. Plan, organize, staff, direct, and control all functions that relate to Enterprise Pharmacy Programs. Achieve targeted performance goals.
2. Define, implement and manage administrative objectives, policies and procedural guidelines through sound utilization of existing facilities and resources.
3. Prepare budgets with revenue projections and cost management objectives and accountabilities.
4. Manage Government contract for Medicare Prescription Drug Program to ensure that all standards are met.
5. Work with other members of executive management to develop effective liaison relationships with a variety of external organizations such as state and federal regulatory agencies, the media, community organizations, professional associations and contracting entities.
6. Guide the development of strategic plans required for Enterprise Pharmacy Programs.
7. Establish and manage relationships with contracted vendors for pharmacy administrative/clinical services to ensure quality, cost effective service.
8. Establish effective processes for rebate management.
9. Negotiate contracts with vendors and partners for services.
10. Ensure that the staff has the required qualifications, training and tools to achieve
objectives.
11. Contribute to and support Enterprise-wide undertakings and commitments.
12. Interpret state and federal legislation (with legal guidance) and draft necessary member benefit certificate language.
13. Direct staff in accomplishing the projects set forth in Enterprise business plans in accordance with the established priorities, goals, and directions of the customer/ client base
14. Manage Retiree Drug Subsidy Program.
15. Ensure that a cooperative and productive climate is maintained with all internal and external contacts.
16. Maintain a good relationship and positive communication with CMS, Blue Cross Blue Shield Association.
17. Serve on various Enterprise committees and task forces.


Travel
The incumbent will attend and participate regularly in client meetings in various locations throughout the country, government training conferences, pharmacy conferences and other meetings as appropriate.


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