Tufts Health Plan – Director, Pharmacy Benefit Management Operations

Reporting to the Vice President of Pharmacy and Health Programs, the Director, Pharmacy Operations is responsible for ensuring pharmacy benefit administration (PBM) operational excellence for all lines of business. Key responsibilities include: a)oversight of operational components performed by the pharmacy benefits management vendor; timeliness and accuracy of formulary drug coding and benefit design implementation b)interpretation, implementation and adherence with state and federal regulatory and compliance requirements c)design, develop and monitoring of key performance indicators, including production of management reporting and executive level dashboards to communicate performance, d) direct the evaluation and implementation of new, value added offerings to enhance the member experience, e)direct the strategy, planning and implementation of PBM system migrations and IT application enhancements, f) collaborate with pharmacy management team to develop and implement trend mitigation opportunities, g) manage the deliverables, performance and development of direct reports: Manager, Pharmacy Operations-Sr. Products, Manager, Pharmacy Operations-Commercial and Public Plans and the Senior Pharmacy Contract Consultant.

EDUCATION: Master’s degree in operations or business administration preferred. Clinical pharmacy degree preferred but not required with commensurate education and industry work experience.

 EXPERIENCE: 10-15 years of health care related experience in medical, pharmacy, hospital or managed care administration. Superior operations management skills required, including knowledge of pharmacy benefit implementation and pharmacy benefit management systems. 5-10 years of management experience, supervising seasoned professionals, having demonstrated success with program implementation and/or measurement, budget and vendor management. Ability to articulate strong understanding of state and federal regulatory and compliance requirements. Must have a proven ability to achieve goals and deliver bottom-line results.

SKILL REQUIREMENTS: Excellent interpersonal skills are required. A high level of diplomacy and effective stakeholder management is necessary to anticipate, recognize and deal effectively with politically sensitive issues and to interact with a wide range of professionals. Role requires frequent verbal, written and in-person communication with Tufts Health Plan departments, external vendors and regulatory agencies. Displays a strong presence that will engender confidence amongst internal staff and stakeholders. Excellent leadership ability to guide and inspire others.

WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS (include special requirements, e.g., lifting, travel, overtime)

CONFIDENTIAL DATA: All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times.

To apply please use the following link: https://recruiting.adp.com/srccar/RTI.home?c=1058241&d=External&r=5000058944406

Contact Information for Candidates or inquiries:
Shauna Maloney