Mutual of Omaha Pharmacy Director (Medicare Advantage)-Omaha, NE or work from home in LAS VEGAS, Nevada
The Pharmacy Director, MoMAC, is an exceptional clinician and communicator who will provide leadership for pharmacy in Mutual of Omaha's Medicare Advantage and Prescription Drug Plans. This role will work closely with vendors to whom Part D operations have been delegated. Success in this role involves leadership in 4 major domains: (1) Pharmacy Clinical Leadership & Strategy, (2) Clinical Quality and Outcomes, (3) Compliance and Delegation Oversight, and (4) Pharmacy Financial Performance. Managing the delegated relationship effectively will be essential to drive performance in each of these domains, while establishing processes for rigorous program oversight, adherence to CMS Medicare Advantage regulations, and identifying both risks and opportunities.
Essential Job Functions:
Pharmacy Clinical Leadership and Strategy
Serves as the clinical leader for pharmacy, and as such, provides leadership in managing internal and external relationships with partners, and in identifying new and innovative strategic and customer-focused opportunities, advising the Chief Medical Officer and other executives, and supporting the development of a compelling clinical vision for pharmacy
Serves as the primary contact for all pharmacy / formulary-related initiatives, financial/rebate performance, trend evaluation, and corresponding clinical strategy & business plan development
Maintains a thorough knowledge of industry trends, as well as trends related to new drugs and therapies
Participates in the bid development and submission process, particularly as it relates to formulary and benefit design
Ensures pharmacy initiatives are customer-focused, and aligned with Mutual of Omaha’s culture, strategy, and brand promise
Clinical Quality and Outcomes
At the direction of the Chief Medical Officer, establishes or participates in clinical teams and committees necessary to ensure plan performance as related to quality, safety, access, adherence, and cost, while driving performance on key STARS measures
Collaborates with delegated vendors to fully leverage data analytics for identification of utilization issues around formulary design and new program development
Compliance and Delegation Oversight
Is responsible for oversight of delegated Part D operations for Mutual of Omaha’s Medicare Advantage and Prescription Drug Plan, ensuring compliance with CMS Medicare Advantage regulations, and working collaboratively with the Chief Compliance Officer
Pharmacy Financial Performance
Reviews trends in Part D claims data and other analytics / reporting to understand plan financial performance and opportunity identification, assist in benefit design, and support contracting with delegated vendor
Sitting 34-66% of the time
Standing/Walking 34-66% of the time
Near Vision - Visual Acuity at 20 inches or less > 66% of the time
PharmD and licensed as a pharmacist
A minimum of 3 years of state/Federal regulatory, Medicare Advantage Plan or Prescription Drug Plan experience.
A minimum of 3 years' experience in Clinical Decision-Making, Coverage Determination and Reconsideration processing.
Considerable knowledge and understanding of the Medicare Managed Care Manual, and operational areas, such as Part D, Claims, Reporting, etc.
Strong and confident leadership in clinical quality & safety, benefit design, clinical program design, and compliance.
Excellent interpersonal, verbal and written communication and presentation skills.
Highly organized, influential and the ability to build consensus within all levels of organization; excellent negotiation skills.
Ability to analyze, interpret and utilize significant data to make sound business decisions
Excellent leadership skills and team building skills; ability to empower team members to meet individual, team and company objectives and motivate.
Ability to maintain a high degree of confidentiality.
Ability to teach and foster development in others
- Previous state/Federal regulatory or Medicare Advantage plan compliance/investigation experience.
If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact a Human Resources Representative at 1-800-780-0304. We are available Monday through Friday 7 am to 4 pm CST.
For all other inquiries, contact our HR Helpline at 1-800-365-1405, option 4.
Mutual of Omaha and its affiliates are an Equal Opportunity /Affirmative Action Employer, Minorities/Female/Disabled/Veteran
To All Recruitment Agencies: We do not accept unsolicited agency resumes and we are not responsible for any fees related to unsolicited resumes.