SummaCare/Akron, OH

SummaCare, a regional health insurance company based in Akron, Ohio is looking for someone to provide Clinical Pharmacological leadership to the Health plan, membership and provider network.

This individual will provide oversight for pharmacy and therapeutic issues, and ensure compliance with pertinent government regulations and standards.

Essential Functions and Responsibilities

Reviews, monitors and recommends changes to prescription programs and formulary including limitations, pre-authorizations, exceptions and non-covered items. Oversees development and administration of Medicare Part D formulary.

Oversees selection, implementation, and performance of the Pharmacy Benefit Manager (PBM).

Assures regulatory compliance of the Pharmacy Department. Provides guidance to staff on operational and regulatory issues including compliance with CMS (Medicare MA and Part D), NCQA, Fraud Waste & Abuse, and ODI guidelines.

Develops and analyzes drug utilization reports, and makes recommendations to Senior Management for interventions.

Oversees Contracting Strategies as related to Pharmacy and Therapeutic issues. Manages Pharmacy & Therapeutics Committee including development of agendas and meeting materials. Reviews all committee actions and recommendations with Clinical Pharmacist and Chief Medical Director.

Educational Requirement

Advanced Degree or may substitute with 6 years of like experience.

Required Experience

5+ years working in Pharmacy Benefit Management either in a Health Insuring Corporation or other managed care environment and experience working with Medicare Part D. Minimum 5 years direct supervisory experience also required.

Required Licenses and/or Certificates

Registered Pharmacist in State of Ohio. Valid driver license.

SummaCare is proud to be a Tobacco-Free Company. Applicants who test positive for nicotine during pre-employment testing are not eligible for hire.

Employment Type: Permanent
Work Hours: Full Time

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