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Innovacare Health operates a growing family of integrated healthcare companies focused on improving the health of patient populations through value-based, coordinated care. Through physician-led models and cutting-edge technology, InnovaCare has built a 20-year track record of growth and a national reputation for excellence. In each unique market the company enters, InnovaCare works across the healthcare ecosystem - with patients, providers, payers and other partners - to increase access to high-quality, coordinated care.
Based in White Plains, N.Y., InnovaCare manages nearly 600,000 lives, including one of the highest percentages of dual-eligible beneficiaries in the nation. Since 1998, InnovaCare and its subsidiaries have been market leaders in transforming healthcare by distributing risk and developing proprietary technologies to inspire patient and provider engagement. The company's physician practices and health plans have continuously received some of the nation's highest scores for quality from the Centers for Medicare and Medicaid Services (CMS).
With strong financial support from a leading global investment firm, Summit Partners, InnovaCare combines management expertise, value-based solutions, best-in-class technology and data analytics to achieve industry-leading outcomes and deliver the best possible experience to members and patients.
Summit Partners is a global alternative investment firm that currently manages more than $19 billion in capital dedicated to growth equity, fixed income and public equity opportunities. Summit invests across growth sectors of the economy and has invested in more than 500 companies in technology, healthcare, consumer, financial and business services, and other growth industries. Summit maintains offices in North America and Europe, and invests in companies around the world.
POSITION DESCRIPTION - Corporate VP of Pharmacy
This opportunity is responsible for the leadership and management of the Medicare Part D program and formulary bid design within FL and Puerto Rico. Ideal candidate will provide technical and leadership skills that ensure successful pharmacy operations and program compliance within the pharmacy department and CMS regulations.
This candidate will be responsible for the development and implementation of a clinical pharmacy plan which includes and is not limited to clinical initiatives that impact drug utilization, clinical education, staff development, management of appropriate drug utilization, drug spend analysis, and quality improvement activities. This position will serve as a subject matter expert in clinical pharmacy operations involved in utilization review and management. The candidate will also assess and provide leadership in the area of clinical pharmacy operations to guide and support the department's strategies. He/she will assist in developing and achieve established targets, develop, implement and coordinate within the pharmacy department's policies and procedures related to implementation of clinical pharmacy operations. Finally, he/she will direct multiple projects and tasks in a fast paced environment, demonstrate the ability to develop a project plan for major projects, and develop milestones for projects to determine outcomes are achieved.Collect, analyze, report, and act on performance and health outcome data to perform the Quality Improvement Program
ESSENTIAL DUTIES AND RESPONSIBILITIES
Ensure success of pharmacy operation model as measured by operational, financial and compliance requirements. Work with Plan Compliance Officer - Medicare, functional managers within Pharmacy and other departments as necessary to negotiate resources, process changes and appropriate training.
Responsible for PBM contract performance and all PBM interface
Develop, implement and manage operational and clinical processes that will ensure cost effectiveness and program compliance.
Develop and monitor management reports which indicate expected services levels, data/processing quality and production volumes of all Medicare Part D operational components.
Contribute to knowledge sharing and understanding of Medicare Part D by creating and providing presentations and training documents related to Medicare Part D pharmacy department operations.
Contribute to the growth of Medicare Part D programs by participation in developing/modifying business processes and target environment as needed.
Implement effective and appropriate program communications plans. Monitor all regulatory data collection, reports, file submissions, CMS guidance and notices. Lead initiatives to communicate changes and modify processes and documentation as needed
Ensure successful internal and external audits by working with operational teams to become SOX compliant. Ensure adherence to appropriate processes, methodologies, policies and procedures.
Work with Senior Leadership to identify and drive resolution to any issues that may hinder program success.
Provide operational guidance for processes which straddle Medicare and Medicaid programs.
Participates in the strategic planning of budgeting and financing of the Pharmacy Program initiatives, especially in regard to planning goals for the future.
Interacts with Senior Leadership, Sales/Marketing, Compliance, Medical and Legal departments.
Provide direction for continual improvement in access and quality of services to members by physicians and other health care professionals associated with the Plan.
Acts strategically and independently with minimal supervision.
Performs other duties for department as requested by supervisor.
Other duties as assigned
EDUCATION AND EXPERIENCE
Pharmacy degree, Doctor of Pharmacy preferred
Active pharmacy license in Puerto Rico
At least 5 year's of Health Plan or PBM related Pharmacy operations experience
Minimum 5-10 years progressively responsible experience leading, managing and/or supervising operational processes, required.
Previous Medicare Part D Experience.
Subject matter expert on Medicare Part D program and process requirements.
In depth knowledge of the Medicare processes and regulatory requirements
Prior experience leading teams dependent upon strong negotiation and management skills.
Prior experience working in health plan operations.
Exceptional leadership capabilities with a strong work ethic, and the ability to keep pace
A dedicated team builder and player who is capable of operating effectively with a minimum of direction, and who enjoys interaction with all levels within an organization.
A resourceful self-starter with a high level of intelligence and energy.
Effective presenter and problem solver.
At least 2 years of direct experience with Medicare Part D, Formulary Management, Clinical Program development, P&T committees
Ability to read, analyze, and interpret the most complex documents. Respond effectively to the most sensitive inquiries or complaints from Members, Pharmacies and/or Physicians. Write speeches and articles using original or innovative techniques or style. Present effectively to Senior Leadership, public groups, committees and/or boards of directors.
Fully Bilingual - English and Spanish
Fundamental knowledge of mathematical concepts related to financial analysis and clinical evaluation.
Define problems, collect data, establish facts, draw valid conclusions and implement appropriate solutions.
Knowledge of CMS Part D rules and regulations
Advanced interpersonal skills
Excellent communication skills, both verbal and written
Computer literacy with word processing, spreadsheet, presentation and email softwares
Interpret and apply Pharmacy utilization and trend data
Ability to apply technical principles and concepts
If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!
Innovacare, Inc. is the leading provider of healthcare management in North America. Through two it's main ways, Medicare Advantage and the provider network, we are committed to healthcare, creating models that are sustainable, cost-effective, and fully integrated with the most advanced technologies. Innovacare, Inc. combines innovation and quality care to create progressive, value-based models, even for the neediest patient populations. Our leadership team, with its vast years of combined experience in managed care and care delivery, is made up of leading experts with proven experience to help healthcare organizations effectively meet and exceed the growing demands of our industry.
InnovaCare Health's foundation was laid by President and CEO Richard Shinto, M.D., in 1998, when he joined North American Medical Management (NAMM) in California. Over the next 10 years, the company continued to grow, acquiring MMM Healthcare in Puerto Rico. In December 2012, the management team successfully sold select NAMM properties and officially formed InnovaCare Health to operate the remaining subsidiaries, including MMM.
MMM Holdings, is a conglomerate of companies that work on Puerto Rico's business strategies, both for Medicare Advantage beneficiaries, through Medicare y Mucho Más (MMM), and for the beneficiaries of the government health plan with MMM Multihealth. Through InHealth Management, it manages the in-hospital care of the beneficiaries, while the specialized clinics, MMM Vita Care, serve members with chronic conditions..... click apply for full job details