Job Description

The vision of Colorado Access is to have healthy communities transformed by the care that people want at a cost we can all afford. Our mission is to partner with communities and empower people through access to quality, affordable care.

Why should you consider a career with Colorado Access?

We are a Colorado-based company, working to improve the health of our state. We care for individuals, families, and children who receive health care under Child Health Plan Plus (CHP+) and Health First Colorado (Colorado's Medicaid Program). Our focus is driving improvements in quality, member experience, outcomes, and cost. We are a mission-driven organization whose foundation is built by our vision and supported by our values.

1. Find work/life balance: We offer PTO, floating holidays, nine company paid holidays, a hybrid work environment, an Employee Assistance Program and a 401K.
2. Be a part of something bigger and make an impact: We serve the underserved and most vulnerable populations in our community through access to quality and affordable health care. No matter what you do for Colorado Access, you are impacting our community and making a difference.
3. Sharpen your skills, learn, and grow: We support your continued development through tuition reimbursement, leadership training, promotion opportunities, performance evaluations, employee recognition, and a language pay stipend.

What you will do

We are looking for a DIRECTOR OF PHARMACY SERVICES who can help shape our vision and support our mission. Here is what the position will look like.

Job Specific Responsibilities:

• Evaluates, develops and maintains an effective pharmacy program by managing the Pharmacy Benefit Management Contract for Colorado Access.
• Manages the Pharmacy Benefit Manager contract, delegation and relationship, ensuring compliant vendor activities.
• Provides oversight and management of all aspects of the Medicaid, CHP+ and marketplace drug benefit programs.
• Monitors and ensures resolution of customer service problems involving the pharmacy contractor, including profiling trends and developing proactive interventions.
• Serves as pharmaceutical consultant to teams across the company that work on related projects and contracts.
• Responsible for ongoing evaluation of the drug formulary.
• Serves as facilitator and provides support to the Pharmacy & Therapeutics Committee. Keeps committee members informed of potential issues and maintains effective communication of formulary changes with providers.
• Communicates protocols to home health pharmacy providers and monitors compliance.
• Works with pharmacy contractors, clinical consultants, the Medical Director, and the Pharmacy & Therapeutics Committee to develop prior authorization or exception criteria and prescribing protocols for oral, topical, infusion, and injectable medications.
• Works with the pharmacy contractor and/or Decision Support to develop and implement standard and customized physician/pharmacy drug utilization review profiling.
• Supervises the research and presentation of quality indicators and utilization profiles to the Pharmacy & Therapeutics Committee.
• Attend meetings to address pharmacy benefits and operational issues.
• Represents Colorado Access at state government-level meetings, as appropriate.
• Develop and monitors pharmacy systems to assure compliance with all regulatory, contract, and NCQA requirements.
• Actively participates in Quality Improvement projects and presents findings to appropriate Quality Improvement Committees.
• Develops policies, procedures, and the operating structure for pharmacy-related quality improvement initiatives and daily operations.
• Supervises pharmacy-related staff, including recruiting, interviewing, hiring, coaching, counseling, and completing performance evaluations.
• Interacts regularly with the Colorado Access provider network and serves as a key liaison regarding pharmacy issues among the health plan, members, and provider community.
• Understands, communicates, and facilitates the complaint, grievance, and appeal process on behalf of members, providers, and ancillary suppliers, including advising these groups of existing resources and initiating processes on their behalf.
• Provides oversight of automated review.

Department Director Responsibilities:

• Provides strategic direction and oversees the management and maintenance of multiple pharmacy department deliverables striving for operational excellence (productivity, quality, SLAs, customer experience of services provided, etc.). Builds high performing teams with vision, leadership, goals and metrics. Serves as a role model for team members; takes action and inspires team members to embrace and implement culture initiatives. Provides awareness to department leaders and staff how their work impacts other departments, programs and the enterprise. Encourages collaboration and holds team members accountable for achieving outstanding results.
• Works closely with other directors to make tactical and operational decisions that advance company strategies and goals and collaborates to deliver on company-wide deliverables/requirements.
• Oversees/leads projects and continuous improvement initiatives across cross-functional teams.
• Develops and implements department policies and procedures to ensure compliance with federal, state, local and company policies, rules and regulations.

What you will bring:

Education: Doctor of Pharmacy Degree (PharmD) required. Residency preferred.

Experience: Minimum of five years of progressive Pharmacy supervisory/management experience is required. Three years of hospital or home health care experience required. One year of managed care experience required. Pharmacy and Therapeutics Committee and Drug Utilization Review/Drug Use Evaluation (DUR/DUE) experience required.

Knowledge, Skills, and Abilities: Contract management, DUR/DUE, P&T committee; Strategic business planning, change management, people management and project management skills required. Demonstrates support for the company’s mission, vision and values. Requires strong analytical and problem-solving skills. Position requires excellent written and verbal communication skills with public speaking/presentation experience. Strong interpersonal and relationship building skills; ability to develop strategic partnerships and work with all levels of staff. Strong organizational and time management skills with the ability to multi-task. Must be proficient in Microsoft office applications (Word, Excel, PowerPoint). Requires the ability to use the complaint, grievance and appeal process, and procedures to facilitate quality outcomes and/or resolutions for the benefit of the members, providers, and Colorado Access. May be required to manage multiple priorities and projects with tight deadlines.

Licenses/Certifications: Active Colorado PharmD licensure required. A valid driver's license and proof of current auto insurance will be required for any position requiring driving.

Together we will be: an innovative and collaborative team who supports each other, the employees and vision of the company to reach our goals individually, together and as an organization.

Pay, Perks and Benefits at Colorado Access:

The compensation for this position is $210,000.00 - $225,000.00 annually. Colorado Access has provided a compensation range that represents its good faith estimate of what Colorado Access may pay for the position at the time of posting. Colorado Access may ultimately pay more or less than the posted compensation range. The salary offered to the selected candidate will be determined based on factors such as the qualifications of the selected candidate, departmental budget availability, internal salary equity considerations, and available market information, but not based on a candidate’s sex or any other protected status.

In addition to being part of a mission driven organization serving our community, as an eligible Colorado Access employee, you’ll receive a generous benefits package, that includes:

• Medical, dental, vision insurance that starts the first day of the month following start date.
• Supplemental insurance such as critical illness and accidental injury.
• Health care and dependent care flexible spending account options.
• Employer-paid basic life insurance and AD&D (employee, spouse and dependent).
• Short-term and long-term disability coverage.
• Voluntary life insurance (employee, spouse, dependent).
• Paid time off
• Retirement plan
• Tuition reimbursement (based on eligibility).
• Annual bonus program (based on eligibility, requirements and performance).

Where you will work:

This position will be a hybrid model work environment, a blend of ‘In-Office’ and ‘Remote.’

We are not able to support out of state employees at this time as we continue to serve our members and community in the metro Denver area and across the beautiful state of Colorado.

Colorado Access is committed to providing equal opportunities to all people regardless of race, color, national origin, age, sex, genetic information, religion, pregnancy, disability, sexual orientation, veteran status or any other status protected by applicable law. We strive to maintain a work environment that is free from unlawful harassment and discrimination.