VP, Pharmacy Benefit Mgr Svcs

Location: Westwood, MA
Job ID: 171898-1A
Date Posted: Nov 2, 2021
Category: Clinical Professional

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Job Description

Welcome To

Welcome to Beth Israel Lahey Health. We are a new health care system that brings together academic medical centers and teaching hospitals, community and specialty hospitals, more than 4,000 physicians and 35,000 employees in a shared mission to expand access to great care and advance the science and practice of medicine through groundbreaking research and education.  

About the Job

The Vice-President of PBM Services will report to the BILH Senior Vice-President, Chief Pharmacy Officer. The primary responsibilities of this position are to develop the PBM strategy and operations for Beth Israel Lahey Health. The position entails managing the relationships between all participating institutions, developing the pharmacy benefit management company, building relationships and negotiating contracts with manufacturers, executing contracts with employer sponsored plans, and developing reporting standards for IDN specialty pharmacies. This role partners with chief pharmacy officers, managers of specialty pharmacies, clinical pharmacists, specialty pharmacy staff, employer sponsored plans and other internal business partners to implement pharmacy benefit contracts with health plans.

Under the guidance of the Chief Pharmacy Officer, the Vice-President of PBM Services will be responsible for leading the strategy and business operations of pharmacy services for the Beth Israel Lahey Health Pharmacy team as determined by organizational priorities. The position entails the implementation of strategic initiatives including expansions and new services, while improving the profitability and sustainability of current and future pharmacy services. The position will also lead payor/pharmaceutical contracting and the development of PBM for the organization. This role partners with pharmacy staff, executive leadership, and other internal and external business partners to build strategic business plans to grow pharmacy services for the enterprise.

The Vice-President of PBM Services is responsible for developing multi-year strategic PBM plans and annual operating plans for Beth Israel Lahey Health; planning, assigning, and directing initiatives in support of all participating institutions related to operating plans; working with consultants and vendors to develop and continually improve services to patients; and drug pricing for the PBM.

Plans, coordinates, and participates in the performance of varied and responsible work in the establishment and operation of specialized programs or projects. Develops, coordinates and advises on policies related to specified activities. Positions may be focused on one program area and/or administrative function (e.g., event planning and coordination, contract administration, marketing, public relations, etc.) or may include more general duties crossing several programs/activities/events or administrative functions.

Responsibilities

  1. Lead the initiatives outlines by Beth Israel Lahey Health PBM business plan and projects assigned by the BILH Senior Vice-President, Chief Pharmacy Officer.
  2. Direct the development, planning, pricing, and implementation of the PBM services under the guidance of the leadership team and executive board.
  3. Manage multiple implementation projects and tasks to meet goals and timelines; procure necessary resources from multiple departments across a large organization to accomplish project tasks; consistently complete projects efficiently and effectively.
  4. Leads the pharmacy services department across multiple enterprises in launching high priority strategic initiatives under the guidance of the Chief Pharmacy Officer, while working directly with the business’s leadership, executives, and stakeholders.
  5. Collaborate with vendors and participating institutions to establish and deploy coalition pharmacy benefit services.
  6. Create an engaging environment that supports continuous individual, group, and self-development within all facets of specialty pharmacy services best practice, including excellence in customer service.
  7. Assist in development and management of key specialty pharmacy services, including but not limited to a) payer contracting initiatives; b) distribution support including call center, prior authorization and mail order; c) accreditation, quality, and performance improvement; and d) market analysis, business intelligence, and data analytics.
  8. Develops long-range strategic plans and objectives through the identification of strategic issues and opportunities that could influence business growth and profitability
  9. Work with self-funded plan, health plans, pharmacy benefit managers, employer groups, government, and other third-party programs to implement a pharmacy benefit (PBM/PBA) solution to gain access to payer networks
  10. Responsible for the execution of strategic initiatives through the development of work plans, gathering and generation of relevant data, driving analyses, and the development of actionable recommendations.
  11. Provide Enterprise subject matter expertise for processes and programs.
  12. Participates as needed in interactions with organization leaders, medical staff, and executives to convey progress in fulfilling strategic goals and key performance metrics.
  13. Assist with the selection and implementation of technology needed to sustain specialty pharmacy clinical, call center, and medication assistance operations.
  14. Develop, implement, and report on clinical and operational measures within the assigned areas of responsibility.
  15. Work with health plans, other insurers, pharmacy benefit managers, employer groups, government, and other third-party programs to coordinate the best pharmacy benefit for clients
  16. Complete evaluation to ensure program implementation and activities adhere to government regulations
  17. Program/Project Management that includes a strong emphasis in program strategy
  18. Meet regulatory, national, and best-practice standards within responsibility areas through continuous monitoring and improvement.
  19. Assist in development and management of key specialty pharmacy services, including but not limited to a) payer contracting initiatives; b) distribution support including call center, prior authorization and mail order; c) accreditation, quality, and performance improvement; and d) market analysis, business intelligence, and data analytics.
  20. Participate in professional associations and actively contribute to the literature through publications and presentations.
  21. Build and execute focused marketing initiatives to help patients, physicians, employer groups, etc., to recognize and easily utilize the services of IDN Specialty Pharmacy.
  22. Support other growth projects as part of the Beth Israel Lahey Health Pharmacy strategic plan.
  23. All others duties as assigned

Qualifications

Education: 

  • Bachelor’s degree in business operations or health care
  • Graduate degree in health administration (MHA) or business administration (MBA)

Experience: 

  • 5+ years in healthcare and/or pharmacy operations
  • Experience in drug pricing, drug reimbursement, and PBM services
  • Experience managing partnerships with manufacturers, employer health plans and vendors
  • Project management experience is strongly preferred
  • Strong organizational skills required.

Skills:

These are the observable and measurable attributes and skills required to perform successfully the essential functions of the job and are generally demonstrated through qualifying experience, education, or licensure/certification.

  • Ability to manage various projects and teams simultaneously
  • Demonstrated record of improving operational efficiencies and improving financial performance
  • Excellent verbal and written skills
  • Understanding of State and Federal regulations; familiarity with the requirements of accrediting organizations
  • Capable of interacting with medical specialties staff (MDs, Nurses, Care Coordinators, etc), and Pharmacy Leadership
  • Strong acumen with establishing and monitoring clinical and business performance measures
  • Knowledge of billing and reimbursement

Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications.  May produce complex documents, perform analysis, and present to senrior leadership and staff