Job Details

Director Of Pharmaceutical Operations

Company name

Inland Empire Health Plan

Organization Type

Public Interest

Job Type

Attorney

Valid Through

Aug 29,2019

Posted on

May 16,2019

Min Salary/Max Salary

USD 150051 to 191256 Annually

Years of Experience

Min 5 yrs required

Location

Rancho Cucamonga, CA, United States

Employment Type

Full-time

Industry

Legal
Practice Area
Litigation >> Litigation - Health Care
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Director of Pharmaceutical Operations
The candidate will create, maintain, and perform a robust Pharmacy compliance program including risk assessments, routine audit and monitoring, regulatory review/analysis, and communication with regulatory bodies in accordance with with applicable California and Federal regulations for the Medi-Cal and Calmediconnect (Medicare) lines of business. Coordinate and lead all external and internal audits ensuring that all documents requests have been reviewed and validated, room coordination/setup is complete, and all information requests are completed on time. Coordinate the development, track, and ensure appropriate completion of all corrective action plans (CAPs) and the development of processes to ensure CAPs do not reoccur. Expertise in CMS, DMHC, DHCS and NCQA is required. Ensure the organization is in compliance with all new laws, regulations, and directives, and develop internal processes to coordinate activities with all appropriate departments and functions. Create a process to monitor all communications from regulatory bodies (ex. APL and DPLs) and communicate those to impacted business units. Review internal policies and procedures to ensure they meet all regulatory requirements such as the 3 way contract, title 22, and Knox Keene. Development and implementation a robust delegation oversight of all vendors and subcontractors for firm Pharmacy Dept. such as PBM, Specialty Pharmacies, MTM, Disease Management and other vendors. Participate and provide representation of the Pharmacy Department at Internal and External meetings / workgroups in relation to compliance and audit/monitoring. Supervision of Pharmacists, Pharmacy Technicians, Analysts, Coordinators and other Staff. Provide ongoing reporting on Pharmacy compliance activities to the Senior Director, Compliance Officer, firm Care Management and Auditing and Monitoring Committee. Act as a knowledgeable internal resource on compliance laws, rules, regulations, policies and other instructions as they relate to compliance of existing and new products. Develop, implement and oversee an optimal Fraud, Waste and Abuse Program. Develop, implement and oversee a pharmacy Grievance and Appeals process in partnership with the firm Grievance and Appeals department. Develop, implement and oversee a best in class Quality Program, ensuring customer service and satisfaction excellence in all areas of the department for firm members, providers and internal customers. Ensures with business owners LEAN standard work development, documentation and adherence. Develop, implement and oversee a Training Program,in partnership with the Learning and Development Department Manager (HR), that promotes quality and compliance excellence and ensures team members are educated to and practice quality, compliant and LEAN standard work. Ensure the privacy and security of PHI (Protected Health Information) as outlined in firm's policies and procedures relating to HIPAA compliance. PharmD or JD degree from an accredited institution is required, or equivalent education. Certificate in Health Compliance Preferred. Should have 5+ years of individual or combined experience in pharmacy operations in an HMO/Managed Care or Integrated Delivery Network (Health System) setting. Should have 5+ years of manager/supervisor level experience: PBM in an HMO/Managed Care or Integrated Delivery Network (Health System) setting. Over 2 years’ progressively responsible regulatory and compliance experience in health care, insurance, or related field. Expertise in CMS, DMHC, DHCS and NCQA is required.

Company info

Hiring Coordinator
Inland Empire Health Plan
P.O. Box 1800
Rancho Cucamonga, CA 91729-1800