Duties & Responsibilities:

• Works collaboratively to design and manage the Healthfirst Pharmacy Benefits for all Healthfirst plans.

• Collaborates with Finance and Actuary to analyze, interpret, and manage pharmacy cost trends for all Healthfirst plans

• Provides support and/or oversight for all clinical and operational aspects of the pharmacy benefit, including elements such as drug formularies, clinical programs, trend management, and go-to-market activities.

• Partners with the leadership team to develop and manage drug related medical coverage policies for all lines of business.

• Performs operational and clinical oversight of PBM (Pharmacy Benefit Manager) data and activities.

• Develops strategies to optimize pharmacy benefits and pharmacy operations across all assigned lines of business.

• Implements benefit changes to align with new or updated federal and state legislation and supports pharmacy benefit-related audits.

• Assists in regulatory and compliance audits for all assigned NYS regulated plans

• Acts as Pharmacy department liaison with vendors and regulatory organizations completing audits for applicable plans.

• Additional duties as necessary

Minimum Qualifications:

• Doctor of Pharmacy degree (PharmD) from an accredited institution

• Licensed Pharmacist in good standing

• Knowledge of regulations of the Centers for Medicare and Medicaid Services and the New York State Department of Health

• Strong clinical knowledge of pharmaceuticals and disease states in order to identify and recommend changes to the formulary.

• Demonstrated critical thinking and problem-solving skills.

• Ability to lead large and small working meetings.

• Outstanding communicator with excellent verbal, written and presentation skills.

• PC Skills with Microsoft Word, PowerPoint (creating presentations and slides), Excel (Pivot tables), Access (creating databases), Visio (creating workflow charts)and Adobe Acrobat.

Preferred Qualifications:

• License to practice pharmacy in the state of New York

• PGY1 Managed Care Residency

• People management or leadership experience

• Knowledge of specialty pharmaceuticals and billing practices in the medical and pharmacy benefits.

• Experience with pharmacy benefit management oversight including maintaining policies and procedures related to formulary design and utilization management processes.

Compliance & Regulatory Responsibilities: Noted above

License/Certification: Licensed pharmacist in good standing.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.