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Clinical Program Director - Pharmacy Solutions at NeueHealth · Doral
Job Description
WHO WE ARE
NeueHealth is a value-driven healthcare company grounded in the belief that all health consumers are entitled to high-quality, coordinated care. By uniquely aligning the interests of health consumers, providers, and payors, we help to make healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.
NeueHealth delivers clinical care to health consumers through our owned clinics – Centrum Health and Premier Medical – as well as unique partnerships with affiliated providers across the country. We also enable providers to succeed in performance-based arrangements through a suite of technology and services scaled centrally and deployed locally. Through our value-driven, consumer-centric approach, we are committed to transforming healthcare and creating a better care experience for all.
JOB SUMMARY
The Clinical Program Director of Pharmacy Solutions will develop and manage pharmacy pathways for various health conditions. Responsibilities include applying deep knowledge of clinical information and regulatory requirements to develop clinical pathways that will provide decision support for our employed and affiliated providers. This position will also provide leadership and manage cross-functional work teams and provide core clinical subject matter expertise for Specialty Solutions’ overall strategies.
DUTIES & RESPONSIBILITIES
The following job description is intended to point out major responsibilities within the role, but it is not limited to these items.
- Collaborate with the Medical Director of value-based care to develop and manage pharmacy pathways for various health conditions.
- Develop the pharmacy pathways section of the tool for all conditions, including incorporating dosage adjustments, contraindications, interactions, side effects, special population adjustments, and allergies in the tool.
- Maintain the most updated pharmacy database in NeuePulse Guide, our clinical decision support tool.
- Support management of the NeuePulse Guide dashboard to educate and correct physician behavior and align physicians with the pathways.
- Work with the Chief Medical Officer and case managers to analyze high-cost patient data for medication improvements, GDR, Polypharmacy.
- Develop and maintain the Centrum Health formulary and generic vs brand drug recommendations.
- Analyze GDR prescription patterns for Centrum members both in and outside of Centrum clinics and recommend generic opportunities.
- Support clinical governance processes. Maintain comprehensive documentation for all clinical guidelines, including rationale, version history, evidence sources, and review schedules.
- Contribute to the development of the methodology and processes to measure and evaluate ongoing performance. Utilize clinical data and system usage metrics to inform updates and refinements.
- Ensure clinical guidelines align with internal policies, applicable regulatory Federal and State requirements, and accreditation standards.
- Identify opportunities for quality and process improvements necessary to facilitate best use of NeuePulse Guide.
- Contribute to training materials, user guides, and clinical documentation. As needed, provide education for staff.
- Other duties and responsibilities as assigned.
EDUCATION AND PROFESSIONAL EXPERIENCE
- Doctor of Pharmacy (PharmD) is required.
- 10+ years of professional experience is required, including 5 years developing and/or managing clinical programs, products, and services. Experience within clinical program management, clinical guideline development, clinical compliance, Utilization Management / Case Management, and / or clinical research preferred.
- Working knowledge and understanding of clinical guidelines required.
- Previous experience managing cross-functional teams on large scale projects required.
- Prior experience with a highly regulated environment including Federal, State and national accreditation standards preferred.
PROFESSIONAL COMPETENCIES
- Experience with problem management, change control and how to influence change without direct control within a decentralized business unit culture.
- Experience managing cross-functional teams with high visibility across products/business capabilities with experience identifying and managing dependencies within and across teams preferred.
- Excellent writing skills, particularly in determination notification writing.
- Ability to develop strong cross-functional and collaborative relationships with internal and external partners, including the ability to work with a wide variety of people and personalities.
- Must be self-motivated, able to take initiative, and ability to thrive and drive results in a collaborative environment.
- Must possess strong organizational and prioritization skills and competence and capacity to handle multiple initiatives while managing conflicting priorities.
- Experience in using the Microsoft Office Suite including Excel and Word as well as demonstrated ability to learn/adapt to other computer-based systems and tools.