Why should you consider a career with Colorado Access?
We are a Colorado-based company, working to improve the health of our state. We care for individuals, families, and children who receive health care under Child Health Plan Plus (CHP+) and Health First Colorado (Colorado's Medicaid Program). Our focus is driving improvements in quality, member experience, outcomes, and cost. We are a mission-driven organization whose foundation is built by our vision and supported by our values.
Find work/life balance: We offer PTO, floating holidays, nine company paid holidays, a hybrid work environment, an Employee Assistance Program and a 401K.
Be a part of something bigger and make an impact: We serve the underserved and most vulnerable populations in our community through access to quality and affordable health care. No matter what you do for Colorado Access, you are impacting our community and making a difference.
Sharpen your skills, learn, and grow: We support your continued development through tuition reimbursement, leadership training, promotion opportunities, performance evaluations, employee recognition, and a language pay stipend.
What you will do:
We are looking for a DIRECTOR OF PHARMACY SERVICES who can help shape our vision and support our mission. Here is what the position will look like.
Job Specific Responsibilities:
Evaluates, develops and maintains an effective pharmacy program by managing the Pharmacy Benefit Management Contract for Colorado Access.
Manages the Pharmacy Benefit Manager contract, delegation and relationship, ensuring compliant vendor activities.
Provides oversight and management of all aspects of the Medicaid, CHP+ and marketplace drug benefit programs.
Monitors and ensures resolution of customer service problems involving the pharmacy contractor, including profiling trends and developing proactive interventions.
Serves as pharmaceutical consultant to teams across the company that work on related projects and contracts.
Responsible for ongoing evaluation of the drug formulary.
Serves as facilitator and provides support to the Pharmacy & Therapeutics Committee. Keeps committee members informed of potential issues and maintains effective communication of formulary changes with providers.
Communicates protocols to home health pharmacy providers and monitors compliance.
Works with pharmacy contractors, clinical consultants, the Medical Director, and the Pharmacy & Therapeutics Committee to develop prior authorization or exception criteria and prescribing protocols for oral, topical, infusion, and injectable medications.
Works with the pharmacy contractor and/or Decision Support to develop and implement standard and customized physician/pharmacy drug utilization review profiling.
Supervises the research and presentation of quality indicators and utilization profiles to the Pharmacy & Therapeutics Committee.
Attend meetings to address pharmacy benefits and operational issues.
Represents Colorado Access at state government-level meetings, as appropriate.
Develop and monitors pharmacy systems to assure compliance with all regulatory, contract, and NCQA requirements.
Actively participates in Quality Improvement projects and presents findings to appropriate Quality Improvement Committees.
Develops policies, procedures, and the operating structure for pharmacy-related quality improvement initiatives and daily operations.
Supervises pharmacy-related staff, including recruiting, interviewing, hiring, coaching, counseling, and completing performance evaluations.
Interacts regularly with the Colorado Access provider network and serves as a key liaison regarding pharmacy issues among the health plan, members, and provider community.
Understands, communicates, and facilitates the complaint, grievance, and appeal process on behalf of members, providers, and ancillary suppliers, including advising these groups of existing resources and initiating processes on their behalf.
Provides oversight of automated…