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GENERAL SUMMARY OF POSITION: 

Under the direction of the Director of Pharmacy, the Pharmacy Operations Manager is responsible for the operations of the MassHealth Pharmacy Program at the Medicaid Office of the Executive Office of Health and Human Services (EOHHS). 

MAJOR RESPONSIBILITIES:

• Provide all staff HR functions including hiring, performance reviews, and termination
• Manage operational activities within Pharmacy Program, to include the Pharmacy On-line Processing System (POPS) Vendor and Drug Use Review (DUR), including identifying tasks and assigning responsibilities to appropriate staff.
• Manage Pharmacy Provider relationships:
• Act as the primary contact with Pharmacy Providers to communicate operational concerns and problem resolution. 
• Organize, convene, and participate in, the quarterly Pharmacy Advisory Council, and other forums which include Pharmacy Providers. Includes:
• Manage the enrollment and credentialing of all Pharmacy Providers.
• Responsible for Pharmacy Program Integrity as it relates to Pharmacy Claims. This includes the following:
• Ensure current claims are adjudicating properly in reference to Drug identification, Drug pricing, Third Party Liability, Member identification, Pharmacy Provider identification, Prescriber identification, and Drug Use Review edits.
• Conduct, or authorize, systematic reviews of past claims to uncover any billing inconsistencies. Review billing trends for problem identification and work with the Pharmacy On-line Processing System (POPS) team to implement policies and procedures to prevent future occurrences.
• Conduct, or authorize, systematic reviews of past claims to identify any instances of aberrant prescribing
• Conduct, or authorize, systematic reviews of past claims to identify any questionable member activity as is related to pharmacy claims
• Oversee the work of the EOHHS Internal Controls Group to ensure proper billing procedures are being practiced.
• Identify billing inconsistencies that would be appropriate to audit. Assist in implementing an audit system for Massachusetts pharmacies.
• Monitor provider compliance with Pharmacy regulations and policies and represent MassHealth at any Hearings resulting from a pharmacy audit.
• Design local (desk) and on-site audits of Pharmacy Providers. Coordinate all pharmacy audit activities being performed by outside vendors.
• Implement sanctioned prescribers procedures in conjunction with Provider Compliance Unit, EOHHS Internal Control and the Attorney General Office.
• Act as primary liaison with the POPS team to develop Change Order Requests necessary to implement modifications as a result of audit/program integrity issues and/or policy or regulation changes.
• Manage the supplemental rebate program. Manage the solicitation, evaluation, and acceptance of bids. Generate and monitor supplemental rebate contracts.
• Assist the POPS Team with the Drug Rebate Program. Work to resolve disputes with manufacturers.
• Coordinate with the Drug Use Review (DUR) staff to implement OCA decisions regarding the MassHealth Drug List, policies and procedures. Make suggestions and give opinions regarding the contents of the MHDL.
• Serve as Editor of “Pharmacy Facts” (the official and binding communication between EOHHS and Pharmacy Providers).
• Serve as the signatory (final reviewer) for updates to the MassHealth Drug List (MHDL) before publication.
• Serve on the MassHealth Pharmacy Policy Committee
• Identify, design, and implement cost savings measures and revenue generating projects that would benefit the Pharmacy program.
• Guide and monitor the operations and evaluation of the Controlled Substances Program (CSMP).
• Act as OCA contact for representatives from the pharmaceutical industry.
• Act as primary Pharmacy Program contact for various state offices and entities and other MassHealth units as it relates to all operational activities for the Pharmacy Program.
• Act as content expert and resource to other organizational units at EOHHS and UMass Medical School on pharmacy and related matters including: Medicare Part D, Specialty Pharmacy, Clinician-administered Drugs, Medical Supplies and Durable Medical Equipment.
• Act as liaison to the Centers for Medicare and Medicaid Services (CMS) for any pharmacy related issues. Coordinate with and support EOHHS staff to initiate changes in the State Plan Amendment when needed for pharmacy related issues.
• Act as an OCA resource for the 340B federal drug discount program. Support Community Health Centers before and after they implement pharmacy services.
• Assist in the development and implementation of the Pharmacy Programs quality improvement program.
• Perform related duties as needed and as assigned.

REQUIRED QUALIFICATIONS:

• Pharm D degree or equivalent combination of education and experience.
• 7-10 years of relevant clinical and management experience, including a minimum of 3 years previous management experience.
• Current licensure as Pharmacist in the Commonwealth of Massachusetts.
• Experience in the application of state and federal Medicaid and Medicare rules and regulations.
• Ability to travel in and out of state.

This is a bybrid position (Work from home/Quincy, MA)

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