Director - Operations/Pharmacy

Qlarant is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Qlarant is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for under-served communities.

Best People, Best Solutions, Best Results

Job Summary:

This position is for the Director - Operations/Pharmacy on the Investigations Medicare Drug Integrity Contractor (I-MEDIC) tasked with detecting, preventing, and proactively deterring fraud, waste, and abuse in Medicare Parts C and D. The Director - Operations/Pharmacy executes strategies that focus on maintaining and enhancing the clinical credibility of the organization and its products, ensuring constant adherence to medical regulations by continuously monitoring the healthcare landscape for emerging trends and practices. Provides leadership, guidance, and support to clinical operations and project teams, ensuring that teams have the necessary clinical information, tools, and expertise to execute their projects effectively. Develops relationships with key stakeholders in the healthcare industry, including regulatory bodies, healthcare providers, and patient advocacy groups, to ensure the company’s products and services are impactful and well-received. Directs the development and implementation of clinical strategies that support broader organizational objectives and aim to revolutionize healthcare delivery and outcomes.

Essential Duties and Responsibilities:

• Directs the organization with regards to developing and implementing medical strategies aligned with the organization's overall goals, and providing clinical advice and information to the teams.
• Delivers clinical oversight and ensures that the organization's products and services comply with regulatory and ethical standards.
• Formulates policies and plans in compliance with the latest medical and/or pharmacy regulations and guidelines, ensuring that the organization adheres to the most up-to-date legal and ethical standards.
• Manages the conceptual design and implementation of projects, as well as ensures project execution, as needed.
• Provides insights on medical trends, advancements, and potential impact on the organization.
• Fosters relationships with healthcare professionals, regulatory agencies, and other external stakeholders to facilitate collaboration and partnerships.
• Executes and oversees quality improvement initiatives related to processes, services, or products.
• Establishes strategies for identifying and mitigating potential clinical risks associated with the organization's operations.
• Develops and provides training and mentorship for employees.
• Coordinates and/or provides educational programs to meet project goals. Contributes professional presentations at pharmacy, medical, and quality organization meetings.
• Contributes newsletter articles applicable to project goals and community needs/requests; contributes abstracts for submission to pharmacy, medical, and quality organizations; and submits memos or reports, as appropriate.
• Testifies at various legal proceedings or administrative hearings, as necessary. Provides direction and subject matter expertise related to pharmacy practice and/or relevant policy to the client and the client’s agencies, including law enforcement.
• Provides workload reports and metrics to clients and/or program leadership, as needed.
• Manages team performance through regular, timely feedback as well as the formal performance review process to ensure delivery of exceptional services and engagement, motivation, and team development.

To perform the job successfully, an individual should demonstrate the following competencies:

• Business Expertise- In-depth knowledge of how own discipline contributes to the Company and good understanding of the commercial environment/market.
• Problem Solving- Requires conceptual thinking in complex/completely new situations.
• Nature of Impact- Through contribution to strategic decisions.
• Area of Impact- Primarily on part of a Group.
• Interpersonal Skills- Skilled communicator who influences and shapes the image of the business (perhaps the industry).
• Leadership- Management responsibility for a team of professionals (includes people, budget, and planning).
• Functional Knowledge- Broad and comprehensive understanding of theories and practices in a theory-based discipline.
• Project Management- Project/Program Manager on large, complex projects or Program Manager on medium size programs who is responsible for oversight of team and budget.  

Education (education can be substituted for experience):

• Bachelor's of Pharmacy required
• Master's degree or PharmD preferred
• Active, current and non-restricted Registered Pharmacist (RPh) license to practice pharmacy in a state, territory of the United States, or the District of Columbia 

Work Experience (experience can be substituted for education)

• Minimum of 15+ years related experience required
• Minimum of five years’ experience in prescription drug benefit management with three years’ experience managing a prescription drug formulary, medication therapy management, and drug interaction program
• Experience concerning the current uses of medications, new or emerging issues, issues related to electronic prescribing, among other general knowledge and experience in the prescription drug benefits
• Experience with the use of Medicare Part D laws, policies, regulations, manuals, and instructions is required, as well as an understanding of Medicare payment policy and operations
• A minimum of one to two years’ experience working in a retail pharmacy as a licensed pharmacist is strongly preferred

Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.