Vice President, Pharmacy

American Health Plans, Franklin, TN 37067, USA

To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation.

• Develop and communicate health services team objectives.
• Establish performance goals for health services staff; ensure continuous feedback regularly, throughout the year.
• Implement and manage cost-effective and high-quality utilization, care, disease management and other clinical programs, including health plan performance reviews, corrective actions, and plans.
• Set performance standards and implement processes to measure qualitative performance regularly and consistently.
• Implement processes to identify developmental needs of team members and a mean of addressing areas of improvement.
• Manage cost of care and utilization to achieve the most effective financial performance while ensuring appropriate quality of care.
• Manage financial performance on a unit cost and operating basis.
• Develop and manage clinical operating budget; participate in strategic planning and clinical model and policy development as requested by leadership.
• Avoid payment of performance penalties and optimize opportunities to earn incentives.
• Other duties as assigned

• 10+ years minimum experience in a management position in managed care, post-degree. Experience with State and external accreditation managed care audits and reviews required.
• Experience with writing and implementing program level policy and procedures required.
• Track record of strong clinical utilization and care program management, general management, supervisory, team building and leadership skills
• Excellent writing and communication skills.
• Direct clinical experience in multiple settings and levels of care, including post-acute care settings.
• Knowledge of relevant federal and state regulations pertaining to managed care and insurance products.
• Proficient with computer and software programs (e.g.; Microsoft Word, Excel) and the Internet required.
• Experience applying medical management treatment guidelines, such as Inter Qual / McKesson, Milliman, or other practical management guidelines required.

Equal Opportunity Employer
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