Healthfirst

The Sr. Manager Medicare Pharmacy is responsible for the overall leadership & management of all Medicare pharmacy benefit plans. The Sr. Manager is responsible oversight of the benefit, partnership with the PBM, providing guidance on HPMS memos, reviewing and leading responses for policy changes and call letters, and maintaining compliance with all Federal and State agencies. In addition, the Sr. Manager will maintain an aptitude for the Medicare Part D and the Medicare health plan business, considers Healthfirst’s position within the industry and assists in the development of a strategic direction of the organization as it relates to pharmacy benefits. The Sr. Manager will also maintain a well-functioning team that develops and maintains flawless Medicare pharmacy benefits for Healthfirst Medicare members. This position reports to the AVP of Pharmacy Benefits and will manage people.

Duties/Responsibilities: Works with the AVP of Pharmacy Benefits and the Clinical Pharmacy Director to design and manage the Healthfirst Pharmacy Benefit for all Medicare plans. Strategically leads the development, planning and implementation of the annual pharmacy benefit cycle to ensure that pharmacy benefits are in-line with Healthfirst Medicare Strategy and PBM capabilities and regulatory timeframes. l Review and facilitate the response and/or the action plan for all applicable CMS memos and other notifications. Collaborate with the Pharmacy team to analyze and present monthly cost trends for all Medicare regulated plans Partners with the Sr. Manager and Clinical Pharmacy Director to develop and manage drug related medical coverage policies for all Supports the AVP of Clinical Strategies to drive improvement of Medicare quality goals Manages the Medicare benefits team and works with others on the Pharmacy team to oversee administration and monitoring of pharmacy benefit operations along with the monitoring of the pharmacy benefits PBM (Pharmacy Benefit Manager).  l Perform Utilization Management reviews of Part B drugs Additional duties as assigned. Minimum Requirements: License to practice pharmacy in the state of New York  PGY1 Managed Care Residency Knowledge of regulations of the Centers for Medicare and Medicaid Services and the New York State Department of Health. Knowledge of specialty pharmaceuticals and billing practices in the medical and pharmacy benefits. Experience with pharmacy benefit management oversight including maintaining policies and procedures related to formulary design and utilization management processes. Experience in Medicare Pharmacy benefit program management License or Certification: Licensed pharmacist in good standing. Preferred Qualifications: A minimum of 2 years’ experience, overseeing a reputable Medicare Pharmacy Benefit Management program for a PBM or health plan. Maintain an active National Certification for Pharmacy and/or Healthcare professionals Compliance & Regulatory Responsibilities: Assists in regulatory and compliance audits for all Medicare plans. Acts as pharmacy department liaison with vendors and regulatory organizations completing audits for applicable plans. Completes all required company compliance standards required for Medicare. License/Certification (if applicable): Doctor of Pharmacy from and Accredited College of Pharmacy A Pharmacy license in good standing in New York State or eligible a New York Pharmacy licensure within 2 years of employment.

Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $117,000 - $179,010 All Other Locations (within approved locations): $100,000 - $153,000 As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.