Director of Pharmacy Quality and Operations

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.

Position Summary

Job Description

Key Outcomes:

• Oversees the administrative functions of the Pharmacy and Mail Order operations, including budgeting, staffing, and performance management. Ensure the department is appropriately staffed to meet operational needs and maintain optimal service levels.
• Develops and leads strategic plans to enhance pharmacy quality operations, aligning with organizational goals, and ensuring high-quality services for health plan members and mail-order pharmacy users.
• Drives continuous improvement in pharmacy quality, establishing programs to monitor, assess, and enhance pharmacy service quality.
• Ensures compliance with relevant regulations, auditing standards, and accrediting bodies (such as NCQA or URAC), ensuring the organization meets required benchmarks and standards. Serve as primary contact between applicable government and regulatory auditing bodies, subject area preparation for onsite visits and evaluations.
• Meets all contractual and legal obligations for payers, federal and state agencies, and accreditation entities for Mail Order pharmacy.
• Ensures continuous assessments of key performance indicators (KPIs) for team performance, regularly monitoring progress, and making adjustments to meet or exceed goals.
• Collaborates across teams to integrate clinical programs within pharmacy operations to improve member outcomes and enhance efficiency.
• Develops and manages the budget for the department, ensuring resources are used effectively to meet operational goals.
• Drives continuous improvements in all operational areas, ensuring exceptional customer service is delivered at all touchpoints. Work proactively to enhance the overall customer experience, ensuring high satisfaction and loyalty.
• Plays a pivotal role in the development and execution of strategies aimed at enhancing member and provider experience. Focus on improving satisfaction, engagement, and retention through various communication and service delivery channels.
• Develops, implements, and ensures continuous quality improvement and process improvement to deliver effective and efficient programs and services.
• Identifies cost-savings opportunities, implement cost reduction strategies, encourage a cost-conscious culture, and adjust strategies based on financial performance.
• Performs other job-related tasks as assigned, demonstrating flexibility and responsiveness to changing needs and priorities.

Education/Experience:

• Clinical degree required, PharmD preferred
• 10 years of professional level experience in health plan setting, clinical quality setting, health care administration, or a directly related field
• Leadership and/or managerial experience Quality Management experience
• Knowledge of Medicare Stars and HEDIS quality programs
• Knowledge of NCQA accreditation
• Experience leading accreditation and clinical process improvement efforts
• Experience managing operational or project budgets
• Experience in a leadership role with direct reports
• Experience with databases and spreadsheets or continuous quality improvement (CQI) tools

Required License(s) and/or Certification(s):

• Valid State of Maine Pharmacist License or ability to sit for licensure within an agreed upon time frame.

Skills/Knowledge/Competencies (Behaviors):

• Demonstrates an understanding of and alignment with Martin’s Point Values
• Knowledge of federal and state laws and regulations and applicable accreditation standards
• Expert knowledge of Medicare Part D regulations
• Proven skills developing high performing teams
• Excellent customer services skills
• Superior written and verbal communication skills
• Knowledge of PBM third party billing, pharmacy claims processing, and pharmacy data management
• Knowledge of dispensing pharmacy operations
• Knowledge of clinical pharmacy programs and formulary management strategies
• Ability to reconcile financial reports and data
• Proficiency in Microsoft Office applications (Word, Excel, PowerPoint)
• Strong organizational skills (ability to prioritize and multi-task while maintaining focus on objectives)
• Strong interpersonal skills and the ability to collaborate with internal and external clients
• Ability to function independently with sound judgment in decision making
• Takes appropriate initiative while soliciting input/advice
• Ability to handle confidential and sensitive information in a discreet and professional manner
• Solid analytical skills

We are an equal opportunity/affirmative action employer.

Do you have a question about careers at Martin’s Point Health Care? Contact us at: jobinquiries@martinspoint.org