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Posted: Saturday, November 5, 2016 12:03 AM

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Company Name: Cascade Comprehensive Care, Inc.

Min Education: BA/BS/Undergraduate
Min Experience: 3-5 Years
Job Function: Pharmacy Director/CPO
Job Type: Full-Time

The Organization
Cascade Comprehensive Care Inc. (CCC) is a managed health care company. CCC currently manages a Medicaid contract under the Oregon Health Plan. CCC handles quality assurance, utilization management, claims adjudication, pharmacy management, encounter reporting, financial and solvency reporting, physician and provider contracting, reinsurance/stoploss issues, risk model management etc. for the local community. CCC is the largest local coordinated health care company in Klamath County with annual revenues of $91 million, and serving approximately 18,000 enrollees. CCC is owned by local health care providers, including primary care physicians, specialists and Sky Lakes Medical Center.

Cascade Comprehensive Care is an equity owner in ATRIO Health Plans and also the local administrator for ATRIO Health Plans Inc. in Klamath County. ATRIO Health Plans is a Medicare Advantage Health Maintenance Organization established by both local physicians and Sky Lakes Medical Center, with a long-term commitment to meeting community health needs. ATRIO's goal is to bring comprehensive, affordable healthcare to Medicare beneficiaries and to provide local access to a company that is dedicated to ensuring customer satisfaction.

The Position

Director of Pharmacy Services: Cascade Comprehensive Care, Inc. is looking for an experienced, passionate and dedicated individual who is responsible for developing and managing the pharmacy claims processing and Encounter Data function, reviewing and adjudicating pharmacy claims, and managing pharmacy prior authorizations. This position is also responsible for managing relationships between PBM and Pharmacy Providers and planning appropriate pharmacy services to members.


The following are essential job accountabilities:
• Renders clinical decisions based on Oregon Administrative Rules, Linefinder (prioritized list), Prior Authorization criteria, Step Therapies, and current formulary choices for approval or denial of benefits.
• Acts as a liaison with pharmacy providers, medical providers, and third party administrators (PBM) to ensure efficient processing of data and claims.
• Prepares and manages clinical formulary under the direction of the Pharmacy &Therapeutics Committee.
• Establishes the appropriate systems for claims and data management for all contracts.
• Manages the processing of all pharmacy claims through a PBM.
• Analyzes claims for appropriateness of services and interprets benefits in accordance with established contracts.
• Assures that all claims are processed correctly.
• Pends claims for eligibility, referral, coordination of benefits, or medical review.
• Manages pharmacy eligibility, authorizations, and claims processing functions.
• Processes pharmacy reports for contract entities including encounter data and management reports.
• Analyzes pharmacy data for trends and cost analysis.
• Prepares data and reports for the Pharmacy & Therapeutics Committee and makes
• recommendations for appropriate pharmacy policies and procedures.
• Prepares management reports under the direction of the VP of Service Operations and Chief Executive Officer for the Board of Directors.
• Provides clinical pharmacy assessment to Medical Providers and clinical staff.
• Reviews new pharmacy published information as it affects the clinical and financial status of the plan.
• Maintains confidentiality and complies with HIPAA rules and regulations.
• Maintains punctual, regular and predictable attendance.
• Works collaboratively in a team environment with a spirit of cooperation.
• Displays excellent communication skills including presentation, persuasion, and negotiation skills required in working with members and coworkers and including the ability to communicate effectively and remain calm and courteous under pressure.
• Respectfully takes direction from manager.

Key Goals & Objectives
• Quickly establish rapport and credibility with staff, physicians and patients
• Gain familiarity and comfort level with systems and engage in staff development
• Establish positive working relationship with the Pharmacy and Therapeutics Committee
• Take ownership in managing multiple programs, including Hepatitis C Program, Diabetic Program, and Opioid Program
• Maintain strong relationship with PBM Committee and oversee formulary design
• Oversee 340B program, finding ways to change or enhance
• Stay current on pharmacy trends and look for potential growth opportunities
• Assist in training new clinical pharmacists
• Be a subject matter expert who can engage at the state level regarding all matters concerning pharmacy

Requirements
• Bachelor’s Degree in Pharmacy
• 3-5 years of related experience, ideally in managed care, with some experience in retail pharmacy preferred
• Registration as a Pharmacist in the state of Oregon is required
• Excellent written/verbal communication, interpersonal, supervisory, mathematical and computer skills

Style and Personal Characteristics
• Ability to work both independently and as a member of a team
• Important to be focused, dependable, professional, personable and hard working
• An energetic, visible, and approachable relationship builder
• A consummate learner with high emotional intelligence
• The ability to engage others with diplomacy and political savvy
• Must be passionate about providing an outstanding level of service
• Well organized with excellent attention to detail
• Ability to manage multiple projects simultaneously
• Excellent follow-up skills
• Strategic thinker who is able to help create, convey and implement best practices.
• Must be passionate about quality and dedicated to the mission of population health management and building a healthy community
• An energizing presence with the ability to build enthusiasm throughout the organization

Compensation
For the selected candidate, a complete and competitive compensation package will be offered which includes salary, major insurances, PTO and relocation and expense reimbursement.

Contact Person: Mark Lukacs
Email Address: mark@greenjobinterview.com
Phone: 707-837-2741

• Location: Klamath Falls, Klamath Falls, Oregon

• Post ID: 16517895 klamath
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