• Job Description

  Req#: R-005206

  Government Employees Health Association, Inc. (G.E.H.A) is a nonprofit member association that provides health and dental benefits that millions of federal employees and retirees, military retirees and their families have counted on since 1937. Offering one of the largest health and dental benefit provider networks available to federal employees in the United States, G.E.H.A empowers health and wellness by meeting its members where they are, when they need care.

  G.E.H.A has one mission: To empower federal workers to be healthy and well.

  The Clinical Pharmacy Manager will oversee the clinical aspects of managing the GEHA pharmacy benefit. This position will provide clinical leadership and oversight within the pharmacy department including direct reports and associated functional teams. This leader will work in tandem with other division leaders, and partner cross-functionally to assist with corporate strategy in achieving better healthcare value and lower cost for our members, while ensuring evidence-based pharmaceutical care. The Clinical Pharmacy Manager will also work in conjunction with division leadership to execute GEHA’s plan for growth, differentiation, and development. This role should be able to meet business needs, adapt to frequent changes and possess a strong skill set for problem-solving and process improvement.
  
  The position will be responsible for the following:
  • Insuring evidence-based medication utilization among our membership through prior authorization criteria development and implementation
  • Upholding defined clinical turnaround times and goals set forth in current contracts, accreditation standards and corporate guidance
  • Providing clinical insight and leadership to direct reports
  • Reviewing formulary, utilization management, and drug pipeline guide GEHA decision making

  SKILLS

  Duties and Responsibilities

  • Responsible for the day-to-day clinical management of the pharmacy benefit, team, and deliverables
  • Provide clinical guidance, support and oversight to the assigned clinical team
  • Independently completes accurate and comprehensive clinical review of internal and external impacts; provides recommendations as applicable
  • Serves as clinical pharmacy SME on projects and clinical care activities
  • Works across internal teams and partners to align strategic initiatives related to HEDIS and member experience optimization
  • Works in partnership with division leadership to implement and maintain regulatory compliance (AAAHC, OPM, OIG, etc)
  • Serve as point of contact for (case management, medical management, appeals, quality, marketing, customer service, customer experience, etc). related to clinical insights and corporate needs
  • Responsible for budget and staffing recommendations and decision for the department

  Job Qualifications

  Education

  • Doctor of Pharmacy (PharmD) degree from an ACPE-accredited School of Pharmacy

  Experience

  • Candidate must be licensed, or eligible for licensure, within the state of Missouri
  • Candidate must have 3 years of health plan experience
  • Candidate must have experience leading direct reports or cross-functional teams
  • Candidate must have experience with healthcare claims data (medical and pharmacy)

  Preferred

  • MBA or demonstrated business background
  • Knowledge of the Medicare Advantage benefits
  • Knowledge of NCQA (HEDIS®) technical specifications
  • Federal Employee Health Benefit (FEHB) experience

  Skills/Certifications

  • Strong collaboration and partnership skills
  • Exemplary organizational skills with the ability to handle multiple projects/issues simultaneously
  • Must possess clear and demonstrative decision-making skills
  • Demonstrate independent, critical thinking skills to understand individual and operational problems and identify solution(s)
  • Candidate should possess an extensive understanding of evidence-based pharmacy practice, including disease specific therapies along with knowledge and ability to search medical literature for supporting clinical references
  • Demonstrate stability of performance under pressure and/or opposition
  • Proficient in Microsoft Office (Outlook, Word, Excel, Vizio and Microsoft Teams)
  • Solid understanding of government scope (FEHB, OPM, FDA, ACA, USPSTF)
  • Competency in compendia navigation and research
  • Excellent record keeping skills, thorough documentation, clear and concise written/verbal communication style

  Reporting Relationships and Contacts

  Reports to the Director of Pharmacy. Primary internal contacts are with Pharmacy Department, Appeals, Medical Directors, Care Management, Medical Management and Quality. Primary external contact will be the health plan pharmacy benefit manager (PBM).

  Working Conditions

  • 40-hour work week
  • Telework or Hybrid work schedule accommodated by management discretion
  • Normal office environment

  Work-at-home requirements

  • Must have the ability to provide a non-cellular High Speed Internet Service such as Fiber, DSL, or cable Modems for a home office.
  • A minimum standard speed for optimal performance of 30x5 (30mpbs download x 5mpbs upload) is required.
  • Latency (ping) response time lower than 80 ms
  • Hotspots, satellite and wireless internet service is NOT allowed for this role.
  • A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

  How we value you

  • Competitive pay/salary ranges
  • Incentive plan
  • Health/Vision/Dental benefits effective day one
  • 401(k) retirement plan: company match – dollar for dollar up to 4% employee contribution (pretax or Roth options) plus a 6% annual company contribution
  • Robust employee well-being program
  • Paid Time Off
  • Personal Community Enrichment Time
  • Company-provided Basic Life and AD&D
  • Company-provided Short-Term & Long-Term Disability
  • Tuition Assistance Program

  While this is a remote opportunity, at this time G.E.H.A does not hire employees from U.S. territories or the following states: Alaska, Hawaii, California, Washington, Oregon, Colorado, Wyoming, Montana, New York, Connecticut, Vermont, Pennsylvania, Maine.

  Please note that the salary information is a general guideline only. G.E.H.A considers factors such as (but not limited to) scope and responsibilities of the position, candidate’s work experience, education/training, key skills, internal peer equity, as well as, market and business considerations when extending an offer.

  The hiring range for this position is $139,812 - $176,870 USD. At G.E.H.A, the current maximum salary for this role is $197,084 USD. While initial compensation may vary based on experience and qualifications, there is a path to work toward this top rate through performance and continued growth within the organization.

  G.E.H.A is an Equal Opportunity Employer, which means we will not discriminate against any individual based on sex, race, color, national origin, disability, religion, age, military status, genetic information, veteran status, pregnancy, marital status, gender identity, and sexual orientation, as well as all other characteristics and qualities protected by federal, state, or local law. G.E.H.A will not discriminate against employees or applicants because they have inquired about, discussed, or disclosed their compensation or the compensation of another employee or applicant. We are committed to creating an inclusive environment for all employees.

  G.E.H.A is headquartered in Lee's Summit, Missouri, in the Kansas City area. We recognize the importance of balance and flexibility and offer hybrid and work-from-home options for many of our roles.

• About the company

  The company currently offers traditional fee-for-service medical plan options with a preferred provider organization along with a high deductible health plan that can be paired with a health savings account.

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