Zing Health is a tech-enabled insurance company making Medicare Advantage the best it can be for those 65-and-over. Zing Health has a community-based approach that recognizes the importance of the social determinants of health in keeping individuals and communities healthy. Zing Health aims to return the physician and the member to the center of the health care equation. Members receive individualized assistance to make their transition to Zing Health as easy as possible. Zing Health offers members the ability to personalize their plans, access to facilities designed to help them better meet their healthcare needs and a dedicated care team. For more information on Zing Health, visit www.myzinghealth.com.
The Manager of Pharmacy reports to the CMO of Zing Health. The Manager will work closely with the Health Services Leadership Team to build innovative, high quality, high value, and cost-effective initiatives. Provide leadership and mentoring to the pharmacy team. Foster collaborative work with internal and external stakeholders. Provide management and oversight of the pharmacy benefit for our products. Ensure pharmacy operations are in compliance with all State and Federal regulatory guidance. All Employed and contracted Plan Pharmacy Staff will report to this position.
Assess CMS regulatory guidance and work with cross-functional groups to implement programs and ensure compliance with Part B and Part D requirements. Lead collaboration with internal stakeholders to drive PBM audits. Lead collaboration with internal stakeholders and PBM to drive audits.
Provide day-to-day management of Zing’s Pharmacy team. Manage issues that are escalated by the team and work to prevent issues from reoccurring through re-design or standardizing processes. Develop or maintain operational reports that quantify and enable management of productivity, quality, and member satisfaction.
Manage formulary using both clinical and
financial analysis of impact. Ensure new drug monographs are provided to Zing
in a timely manner with recommendation for inclusion/exclusion as well as
utilization management and/or benefit positioning.
Manage vendor and internal programs and processes to ensure compliance with regulatory bodies. Manage vendors’ (e.g. Pharmacy Benefit Management (PBM), specialty pharmacy) contractual obligations and expectations. Coordinate efforts and implement solutions for identified issues in a timely manner. Create vendor monitoring initiatives in relation to regulatory and business changes (e.g. new ventures). Create and optimize vendor policy development and implementation. Participate in regular vendor operational meetings. Participate in request for proposal (RFP) processes when evaluating vendors.
Leverage data and other information to identify opportunities for process improvement or cost reduction. Collaborate with others to design and implement quality improvement projects. Participate on various physician-led committees such as the Medical Policy Committee, Safety and Clinical Quality committee, Quality Improvement Committee, and Clinical Policy and Process Committee.
Align with analytics and actuaries to interpret claims data for reporting and general trend analysis. Collaborate with benefit configuration process. Identify issues and implement solutions. Ensure effective workflows, maximize system efficiencies, monitor quality performance measures, and confirm appropriate completion of work assignments. Drive change as appropriate. Assist in and/or establish department objectives that support organizational goals and produce regular status reports. Assist in and/or prepare an annual operating budget that reflects the forecasted needs of the department and control expenditures to assure adherence to approved budgets.
Initiate personnel action such as hiring, coaching, termination and/or salary recommendations. Foster training, coaching, and motivation of employees including career path development. Assess individual employee performance and conduct timely performance appraisals. Promote teamwork, discussion, and cooperation among staff and other departments. Ensure timely communication and sharing of information with team members. Work with staff to resolve work-related issues and concerns. Promote a respectful and diverse workplace. Develop and maintain Pharmacy policies and procedures.
document describes the major duties, responsibilities, and authorities of this
job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that
incumbents may be asked to perform job-related duties beyond those explicitly
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
QUALIFICATIONS AND REQUIREMENTS:
- Experience: Five years managed care, or a combination of two years managed care and three years PBM
- Prior MAPD Plan Leadership role
- Education: Doctor of Pharmacy (Pharm D) from an accredited School of Pharmacy and a Registered Pharmacist (RPh)
- Certifications/Licenses: An active unencumbered Pharmacist License in the United States
Knowledge, Skills and
- 5 years Medicare Part D/Part B experience
- PBM Processes
- Part D Coverage Determinations
- Pharmacy Appeals and Grievances
- Pharmacy claims processing systems
- Data Analytics and financial analysis
- Pharmacy Formulary Committee
- Operational processes
- Interpersonal Skills
- Verbal and written communication
- Microsoft Office – Intermediate
- Development and Interpretation of Pharmacy Reports
- SQL/Tableau Experience
- Coaching and development of Staff
- Organizational and project planning
- Pharmacy Utilization
- Clinical Pharmacist
- EOC/PBP Development and Submission
- Formulary Development and Management
- Communicate effectively with both internal and external customers
- Work independently
- Communicate with a diverse audience (both internal and external)
- Working knowledge of medication therapy management programs
- Medical Economics Committee experience
- Industry Pharmacy Consulting Experience