Director Pharmacy Compliance

The role is responsible for managing the day-to-day pharmacy financial and audit operations. This role serves as the primary contact with the for-accounting issues and works closely with internal and external auditors. It is also the internal subject matter expert on pharmacy financial operations, directing projects and initiatives to develop strategic recommendations for improvements in pharmacy financial operations. This role manages and oversees financial aspects of over $6 Billion in yearly drug spend, ensuring vendors comply with all contractual performance guarantees.

• Pharmacy Finances: Serves as the primary liaison to vendors and stakeholders, evaluates health care legislation and business trends, provides financial controls oversight, and guides contract negotiations.
• Financial Compliance and Audit: Serves as the primary liaison to vendors and stakeholders for Pharmacy Programs audits. Directs cross-functional teams to enhance Pharmacy Benefit Manager compliance, negotiate favorable contracts, and ensure member benefits compliance. Coordinates with local plan divisions on waste, fraud, and abuse efforts.
• Process Management: Manages bi-weekly check writes for drug spend, maintains vendor interactions, and promotes effective management across the organization.
• Client Relations/External Relations: Serves as liaison and subject matter expert in the pharmacy industry with the Blue System, Government Agencies and industry representatives. The purpose of these interactions is to build professional relationships and enhance knowledge of the pharmacy industry.

The posting range for this position is:

113,572.92 - 153,590.12

Qualifications:

Education

• Required Bachelor's Degree in either Pharmacy, Business, Economics, Management of Health Services, or equivalent work experience
• Preferred Master's Degree in health services or equivalent work experience

Experience

• Required 7+ Years business experience with a national health care and managed pharmacy delivery system

Knowledge Skills and Abilities

• Leadership: Demonstrated project/program leadership, setting priorities, and achieving objectives in complex projects with multiple stakeholders.
• Advanced knowledge: Financial accounting, controls, auditing, customer services, claims processing, market research, benefits delivery, quality assurance, and contract administration.
• Strategic Abilities: Building organized strategies related to department/divisional goals.
• Stakeholder Management: Ability to manage stakeholders, reconcile competing interests, and work in a decentralized decision-making structure.
• Motivation: Highly motivated individual with an understanding of health care professionals’ interactions within the overall context of health care.
• Collaboration: Incorporating perspectives from other functional areas and developing alternative approaches.
• Technical Skills: Proficient in information technologies (e.g., Microsoft software applications).
• Communication: Excellent written and oral communication and interpersonal skills across all levels.

Certifications & Licenses

• Preferred: CPHM - Certified Professional in Healthcare Management - AIHM
• Preferred: Certified Management Accountant (CMA) - Institute of Management Accountants
• Preferred: Certified Public Accountant (CPA) - Various

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