Deputy Director of Pharmacy Operations

Position Overview Empower. Unite. Care. MetroPlus Health is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. The Deputy Director of Pharmacy Operations is responsible for oversight and day-to-day operations of the MetroPlusHealth drug benefit as provided via the medical and pharmacy benefit. The Deputy Director will lead the team responsible for coordination with internal benefit design stakeholders and Regulatory and Compliance teams to ensure a compliant drug benefit is maintained. This position will work closely with the Pharmacy Benefit Manager (PBM) to ensure pharmacy benefits are operating as intended. This position engages with senior leaders and key stakeholders to ensure the optimal utilization of technology and resources, to support the implementation of enterprise-wide pharmacy systems and processes, including large-scale operational projects. Additionally, this position is responsible for ensuring fraud, waste and abuse risks are identified and addressed through internal monitoring and partnering with the

PBM, MPH

Special Investigation Unit (SIU) and oversight of the Restricted Recipient Program (RRP). Scope of Role & Responsibilities Executes day-to-day operations including but not limited to working with the PBM and internal teams to monitor drug spend and trends. Work with MPH Product, Finance and Regulatory teams to ensure drug benefits are configured as intended and within compliance with new and existing regulations. Supports strategies and programs for delivering pharmacy services across the plan to achieve high quality, affordable health care that improves our members' lives. Supports monitoring and oversight to ensure PBM and pharmacy vendors meet contractual obligations. Create oversight processes to control costs and mitigate FWA risk. Delivers information and recommendations pertinent to external pharmacy industry trends and developments that represent risk and opportunities for the organization. Supports management of MetroPlusHealth formularies. Oversee the Restricted Recipient Program (RRP) and ensure the program is implement in accordance with the New York State Department of Health (NYSDOH) Managed Care Contract - Appendix Q. Required Education, Training & Professional Experience Doctor of Pharmacy required Minimum 8 (eight) years of pharmacy practice experience required Minimum of 4 (four) years of experience in pharmacy management of government programs (Medicare, Medicaid), required Supervisory experience in managed care environment required Experience in formulary and criteria development/management preferred Prior experience completing evidenced based formulary reviews, supportive literature evaluation, participation in clinical pharmacy programs, presenting clinical information to providers and committees preferred Proficiency with MS Word, Excel, and PowerPoint is required. Experience in the evaluation and interpretation of pharmacy claims data and other clinical data is preferred. Required Licensure and/or Certification Valid license and current registration to practice as a Pharmacist issued by the New York State Department of Education (NYSED). Professional Competencies Integrity and Trust Customer Focus Functional/Technical skills Written/Oral Communication Time Management Teamwork #LI-Hybrid #MPH50