Pharmacy Manager - Government Programs
Blue Cross Blue Shield Kansas

Job Info

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Under the general direction of the Chief Pharmacist, the pharmacy manager of government programs will oversee pharmacy management of government healthcare programs, including Medicare, and the Federal Employee Program (FEP), and other government-sponsored lines of business. This role ensures the effective management, compliance, and optimization of pharmacy operations within these programs. The pharmacy manager will work closely with cross-functional teams and our pharmacy benefit manager (PBM) to ensure high-quality services, operational efficiency and adherence to government programs.

"This position is eligible to work onsite or hybrid (9 or more days a month on site) in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment."

Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.

Why Join Us?

• Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
  
• Family Comes First: Total rewards package that promotes the idea of family first for all employees.
  
• Dynamic Work Environment: Collaborate with a team of passionate and driven individuals.
  
• Stability: 80 years of commitment, compassion and community
  
• Flexibility: options to work onsite or hybrid available
  
• Balance: paid vacation and sick leave with paid maternity and paternity available immediately upon hire
  
• Inclusive Work Environment: We pride ourselves on fostering a diverse and inclusive workplace where everyone is valued and respected.
  
  

Compensation

$130,800 - $155,000 annually

Exempt 19

• Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.
  
  

What you'll do

• Oversee the activities of the pharmacy benefit manager (PBM) in the administration of pharmacy benefit programs, such as benefit designs, network development, formulary decisions, and utilization management programs, as well as forming recommendations for program changes.
  
• Responsible for oversight of pharmacy programs and ensuring solutions are performing to expectations.
  
• Lead initiatives to manage changes in government programs or regulations, ensuring timely updates to pharmacy operations.
  
• Manage and support medication therapy management (MTM), adherence, STARS programs, and other quality-based initiatives, and develop and implement strategies for improving performance.
  
• Ensure pharmacy operations comply with all federal and state regulations.
  
• Develop, implement, and evaluate policies and procedures related to pharmacy services within government programs.
  
• Supervise and mentor clinical and non-clinical pharmacy staff involved in government program activities.
  
• Participate in meetings and committees related to government program initiatives, representing pharmacy interests.
  
• Collaborate with clinical teams to enhance patient care through medication management programs and services.
  
• Will be an active participant and representative of the Medical Affairs Division on multiple cross-functional committees and work teams as assigned.
  

What you need
Knowledge/Skills/Abilities

• Requires knowledge of formulary development, including pipeline analysis and trade impact.
  
• Requires knowledge of health plan/pharmacy benefit manager (PBM) interfacings and the ability to navigate between stakeholders from both entities
  
• Requires a working knowledge of pharmacy and professional provider business procedures and practice economics and the ability to apply this knowledge to acceptable reimbursement policy and network development.
  
• Requires detailed knowledge of pharmacy and professional claim adjudication systems, electronic claims processes and electronic prescribing. Requires a working knowledge of coding methodology, including CPT, HCPCS and ICD-9/ICD-10, and medical terminology.
  
• Requires knowledge of pharmaceutical care, drug utilization review, disease state management, and utilization management, including Department of Labor (DOL) standards and URAC accreditation.
  
• Requires detailed and expert knowledge of drug therapy, biologic and biopharmaceutical products, drug information systems and drug delivery systems. Requires knowledge of the pharmaceutical industry, biologic and biopharmaceutical product development and the FDA approval process.
  
• Requires knowledge in the evaluation of clinical drug trials, outcomes research and Pharmacoeconomics and the ability to apply this knowledge to the development of drug formularies and utilization management and drug utilization review programs.
  
• Requires an understanding of empathy with people as well as effective principles of communication, team participation and leadership and continuous quality improvement principles.
  

Education and Experience

• Bachelor of Science in Pharmacy or Pharmacy Doctorate required, MBA or MPH preferred
  
• Must have or be able to obtain a current, unrestricted license to practice pharmacy by the Kansas State Board of Pharmacy
  
• Minimum of five years of experience in pharmacy practice
  
• Minimum of two years of experience in a leadership role
  
• At least one year of experience in managed care pharmacy and/or government programs, preferred.
  

Physical Requirements

• This position requires minimal lifting up to 20 pounds. Position is mainly stationary with use of the PC at least 75% of the workday.
  

Benefits & Perks

• Base pay is only one component of your competitive Total Rewards package
  
• Incentive pay program (EPIP)
  
• Health/Vision/Dental insurance
  
• 6 weeks paid parental leave for new mothers and fathers
  
• Fertility/Adoption assistance
  
• 2 weeks paid caregiver leave
  
• 5% 401(k) plan matching
  
• Tuition reimbursement
  
• Health & fitness benefits, discounts and resources
  

Our Commitment to Diversity, Equity, Inclusion, and Belonging

At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of diversity, equity, inclusion, and belonging (DEIB), where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law.

We believe that embracing diversity and authentically promoting inclusion, equity, and belonging among our team members is crucial to our collective success. By intentionally recruiting, developing, and retaining a diverse pool of talent, we cultivate an environment where everyone feels valued, heard, and empowered to contribute. Accommodations are available for applicants with disabilities upon request, ensuring an inclusive and accessible hiring process for all.

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