What are the responsibilities and job description for the Medicaid Pharmacy Director position at Nebraska Department of Health and Human Services?
The State of Nebraska, Department of Health and Human Services, within our Medicaid and Long-Term Care Division, is actively seeking a dynamic individual to serve as the Medicaid Pharmacy Director. Based in Lincoln, this pivotal role plays a crucial part in ensuring the well-being of Nebraskans through comprehensive pharmacy services.
You have the passion, we have the opportunities - let's make a difference for Nebraskans!
Examples of Work
The Medicaid Pharmacy Director:
- Provides daily management for the MLTC Pharmacy Program of over $250,000,000, including oversight of and support for the operation of the Heritage Health Managed Care Organizations' pharmacy benefit.
- Provides oversight to the MCO pharmacy programs relative to the Heritage Health contract requirements,
- Ensures compliance with complex CMS rules, state regulations, and general provisions of the Pharmacy Program.
- Interprets departmental policies, regulations, and federal guidance governing pharmaceutical services.
- Manages the Drug Utilization Review (DUR) contract and provides oversight of the DUR program and functions.
- Manages pharmacy participation in the health management program involving utilization and care management strategies relative to the model of population health.
- Interacts with the data and analytic team and medical director to support evidenced based care.
- Assists in developing programs, policies and procedures for the coverage of, dispensation, payment, and rebating of pharmaceuticals for Medicaid clients.
- Reviews practices and policies to ensure compliance and assists with audits.
- Conducts and participates in meetings to review and communicate Medicaid program needs.
- Supervises pharmacy staff and acts as liaison between pharmacy providers, pharmaceutical manufacturers or associations and the Department of Health and Human Services.
Requirements / Qualifications
Minimum Qualifications: Graduation from an accredited school of pharmacy and licensed to practice pharmacy in the State of Nebraska, plus four years of full-time experience as a licensed pharmacist
Preferred Qualifications: Experience with population health and care management protocol development.
Residency training preferred.
Experience with managed care organizations and pharmacy benefit managers a plus.
Surveillance and auditing with data analytic experience is preferred.
Knowledge / Skills / Abilities
Knowledge of: The professional principles and practices of pharmaceutics, pharmaceutical economics, federal and state laws regulating the practice of pharmaceutics and Medicaid policies and procedures with regards to pharmaceutical practice.
Skill and Ability to: Collaborate with the managed care organizations and other stakeholders to support quality initiatives and effective utilization of pharmacy services relative to population heath and the quadruple aim. Ability to develop standards for use in policy determination and setting of regulations governing the prescribing, dispensing and payment of drugs in the public welfare program, make a detailed analysis of pharmaceutical services and recommend a course of action, express ideas effectively orally and in writing, establish and maintain effective working relationships with professional and lay personnel at various levels inside and outside the Division.
Benefits
We offer a comprehensive package of pay, benefits, paid time off, retirement and professional development opportunities to help you get the most out of your career and life. Your paycheck is just part of your total compensation.
Check out all that the State of Nebraska has to offer! For more information on benefits currently offered to permanent teammates, please visit: https://statejobs.nebraska.gov/index.html#benefitse.
