Summary: Provides comprehensive management and leadership for the Presbyterian Health Plan (PHP) Pharmacy Department. Manages the PHP pharmacy benefit for all product lines. This includes oversight of the prior authorization process, formulary management, and regulatory compliance. Coordinates clinical programs and services offered by the department including educational programs for members, providers, and PHP staff.
Initiates and follows through with the annual strategic planning process which includes the development of all strategic objectives and tasks for the department, creation and implementation of written work plans for all major tasks and tracking to ensure maintenance of timelines for completion of tasks.
Ensures optimal performance of all PHP Pharmacy Department functions including but not limited to:
Oversight of PBM for Prior Authorization process.
Drug utilization reviews and identification of areas for improvement.
Management of the PHP formularies
Coordination and Facilitation of PHPs Pharmacy & Therapeutics Committee.
Educational programs for members to enhance knowledge, compliance, and cost-effective therapy.
Functions as the Pharmacy Department lead in interactions with other PHP departments to provide assistance with their functions including UM, care coordination, Quality, Measurement Improvement, marketing, enrollment, provider services, and other functions as indicated.
Consultation in the development of Disease Management programs.
Reporting of drug utilization patterns to delegated physician groups.
Evaluates per member per month pharmacy costs and develops innovative mechanisms to favorably affect these costs while maintaining or improving quality of care.
Supports PHP efforts in regulatory compliance as these requirements or standards relate to the pharmacy department function.
Serves as the liaison between the PHP Pharmacy Department and external organizations such as state medical societies, pharmacy organizations, OSI, HSD, and other MCOs, to promote the best interests of PHP.
Performs other functions as required.
Doctorate degree in Pharmacy (PharmD.) or Registered Pharmacist (RPh) with extensive clinical experience.
New Mexico Board of Pharmacy License required.
Minimum of 5 years experience in a Clinical Setting and a minimum of five years experience in managed care or associated field preferred.
Health Plan Pharmacy leadership experience required.
Residency and Board Certification preferred.
Benefits Benefits are effective day-one and include:
Full medical, dental and vision insurance
Flexible spending accounts (FSAs)
Free wellness programs
Paid time off (PTO)
Retirement plans, including matching employer contributions
Continuing education and career development opportunities
Life insurance and short/long term disability programs
About Us Presbyterian Healthcare Services is a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, it is the state's largest private employer with approximately 11,000 employees.
Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, employees, board members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than 700,000 New Mexicans.
We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.
About New Mexico New Mexico's unique blend of Spanish, Mexican and Native American influences contribute to a culturally rich lifestyle. Add in Albuquerque's International Balloon Fiesta, Los Alamos' nuclear scientists, Roswell's visitors from outer space, and Santa Fe's artists, and you get an eclectic mix of people, places and experiences that make this state great.
Cities in New Mexico are continually ranked among the nation's best places to work and live by Forbes magazine, Kiplinger's Personal Finance, and other corporate and government relocation managers like Worldwide ERC.
New Mexico offers endless recreational opportunities to explore, and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
Additional Salary Information: Bonus earning potential through the PHS Management Incentive Plan (MIP).
Internal Number: 2020-13969
About Presbyterian Health Plan
Presbyterian Healthcare Services exists to improve the health of the patients, members and communities we serve. We are a locally owned and operated not-for-profit healthcare system known nationally for our extensive experience in integrating healthcare financing and delivery.
We’ve grown from a small tuberculosis sanatorium founded in 1908, to a system of nine hospitals, a multi-specialty medical group with more than 900 providers and a statewide health plan. We serve one in three New Mexicans with healthcare or coverage.
Our regional hospitals provide both acute and preventive care: from surgical, ambulatory and emergency services to health fairs, fun runs, and prevention and screening programs. We seek to provide the most affordable and effective care possible. To help achieve this goal, we continue to look toward the future, making prudent investments in modern equipment and technology – such as MyChart and Video Visits – that make patient access and care management easier, more convenient and affordable.
We are governed by a volunteer Board of Trustees comprised of community leaders. These individuals have included members of the Navajo Nation, theologians, busine...ss leaders, educators, medical administrators and others. They donate their time and energy to ensure that we maintain superior caregiving, deliver high-quality healthcare and work tirelessly to create a healthy New Mexico, now and for years to come.