Payer Strategy Manager Jobs in Peru, IN (NOW HIRING)

Job Summary

Responsible for the strategic, operational, clinical, financial, and regulatory leadership of Marion Health Pharmacy Services, including inpatient pharmacy, outpatient retail pharmacy, medication distribution and clinical pharmacy programs, and other ambulatory, specialty, and transitions-of-care pharmacy services as developed. Ensures pharmacy services are delivered safely, efficiently, cost-effectively, and in compliance with applicable federal and state laws, Indiana Board of Pharmacy requirements, DEA requirements, ACHC accreditation standards, and Marion Health policies. Provides leadership for medication-use systems, pharmaceutical purchasing and inventory, revenue and expense management, third-party reimbursement, 340B program oversight, quality improvement, pharmacy technology, workforce development, and strategic growth of pharmacy services.

• Provides administrative and operational leadership for all pharmacy services, including inpatient pharmacy, outpatient retail pharmacy, clinical pharmacy programs, medication distribution, and other ambulatory or specialty pharmacy services as developed.
• Provides oversight leadership of the outpatient retail pharmacy operations, including licensure and regulatory readiness, prescription workflow, staffing, patient service, inventory control, purchasing, cash controls, third-party payer and pharmacy benefit manager requirements, claims processing, reimbursement, reconciliation, and compliance with applicable retail pharmacy standards.
• Leads the development, implementation, and ongoing performance of Meds-to-Beds and other transitions-of-care pharmacy services in collaboration with nursing, providers, case management, revenue cycle, and other clinical departments to improve medication access, adherence, and continuity of care.
• Evaluates and develops opportunities to expand ambulatory and specialty pharmacy services, including assessment of service-line needs, payer access, accreditation requirements, staffing, technology, financial feasibility, and integration with Marion Health clinical programs.
• Implements and monitors compliance with hospital and department policies and procedures and with applicable federal, state, accreditation, and professional standards, including requirements of the Indiana Board of Pharmacy, DEA, IDOH, CMS, and other regulatory or accrediting bodies.
• Maintains effective systems for controlled-substance accountability, diversion prevention and monitoring, medication security, dispensing accuracy, compounding, repackaging, record retention, and other medication-use processes.
• Provides leadership for medication safety, formulary management, Pharmacy and Therapeutics activities, clinical pharmacy programs, drug-use evaluation, quality improvement, and evidence-based medication-use practices.
• Develops and manages pharmacy operating and capital budgets, revenue and expense performance, productivity, reimbursement, billing accuracy, drug-cost trends, financial variances, and opportunities to improve pharmacy contribution margin while maintaining quality and patient access.
• Directs pharmaceutical purchasing, procurement, inventory management, shortage mitigation, contract utilization, wholesaler relationships, formulary economics, and medication availability to support uninterrupted patient care and responsible stewardship of resources.
• Provides executive oversight of the 340B Drug Pricing Program, including program governance, eligibility, purchasing, inventory methodology, contract pharmacy relationships as applicable, audit readiness, internal controls, compliance monitoring, and optimization consistent with federal requirements and Marion Health policy.
• Oversees pharmacy information systems, automation, dispensing technology, interfaces, data integrity, and performance analytics; establishes and monitors key performance indicators for quality, safety, service, productivity, financial performance, and patient access.
• Recruits, develops, evaluates, and retains pharmacy personnel; establishes appropriate staffing models, competency expectations, orientation, continuing education, succession planning, and performance standards for pharmacists, technicians, and support staff.
• Collaborates with medical staff, nursing, administration, finance, revenue cycle, compliance, information technology, supply chain, and other departments to advance safe medication use, patient access, operational efficiency, and organizational priorities.
• Translates Marion Health strategic goals into pharmacy priorities, evaluates emerging pharmacy practice models and regulatory changes, and develops business plans and implementation strategies for new or expanded pharmacy services.
• Maintains professional competency and, when operationally necessary, may perform pharmacist duties consistent with Indiana law, licensure, hospital policy, and departmental procedures.

Minimum Job Requirements

• Graduate of a School of Pharmacy accredited by the American Council on Pharmaceutical Education with a minimum of a Bachelor’s Degree in Pharmacy.   
• Must be eligible for licensure as a pharmacist in the State of Indiana and maintain such licensure in good standing.
• Five years of progressive pharmacy experience, including at least three years of pharmacy leadership or management experience in a hospital, health-system, or similarly complex pharmacy environment.
• BLS certification or must obtain during orientation and prior to reporting to department.

Preferred Job Requirements

• Doctorate in Pharmacy degree from an accredited university or college
• Five years of progressive health-system pharmacy management experience with demonstrated leadership responsibility.

Skills / Knowledge / Abilities

• Advanced knowledge of pharmacy operations, professional standards, governmental regulations, and business practices applicable to inpatient pharmacy, outpatient retail pharmacy, medication safety, controlled substances, 340B program management, third-party reimbursement, payer/PBM requirements, pharmacy purchasing, inventory management, and health-system pharmacy services.
• Excellent communication skills to effectively and tactfully communicate with patients and their families and guests, co-workers, managers, Hospital Administrators, providers, consultants, business associates and regulatory agencies presenting a professional image as a representative of Marion General Hospital.
• Interpersonal skills necessary in order to carry out duties in a professional manner.
• Excellent time management.
• Ability to problem solve, multi-task in a fast-paced setting and work well in a team environment.
• Ability to negotiate effective working relationships and develop positive resolution to conflict. 
• Highly developed computer skills to include proficiency with Microsoft Office and the ability to learn and proficiently perform computer applications related to department operations and job function.
• Excellent customer service skills.
• Strong organizational, financial, leadership and administrative skills to manage multiple issues simultaneously combined with ability to effectively prioritize. 
• Excellent management skills. 
• Ability to effectively perform job functions under periods of extreme stress, meeting deadlines and producing positive outcomes. 
• High degree of accuracy with concentration and close attention to detail.
• Requires the ability to be discreet and protect the integrity of any confidential matter or information encountered during the performance of job duties.

Working Conditions

• Typical hospital clinical environment with frequent standing and walking. 
• Work may be subject to interruptions and occasional high stress levels. 
• Risk of occupational exposure to blood and other potentially infectious, electrical and radiation hazards. 
• Ability to work hours beyond the normal work week. 
• Works with highly confidential information which may be proprietary or protected health information. 
• May attend special functions and meetings at various locations within the hospital and community. 
• Occasional overnight stays.

Physical and Mental Activities, Tools and Equipment

• Uses computer and standard office equipment. 
• Lifting, pushing, pulling, walking sitting, reaching, bending, kneeling or stooping to perform duties in a safe manner.

Equal Opportunity Employer
Marion Health is a smoke-free environment.