Director, Clinical Operation

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 a key personnel role for the Plan Program Integrity Medicare Drug Integrity Contractor (PPI MEDIC) serving as the pharmacy specialist. The overall strategy for the Plan Program Integrity Medicare Drug Integrity Contractor (PPI MEDIC) is to conduct Medicare Parts C and Part D proactive data analysis and identify program vulnerabilities. These preliminary findings shall be provided to the Medicare Advantage (MA) and Prescription Drug Plans (PDPs) for further review, analysis, corrective actions as needed and support their overall fraud, waste and abuse (FWA) monitoring efforts. Responsible for leading and contributing to the successful performance of the team by supporting and directing pharmacists, nurses, and subject matter experts as well as other managerial functions in the program. Responsible for ensuring assigned projects and contracts related to the clinical team are accurate to achieve customer and organizational objectives. Ensures the scientific integrity and accuracy of the work product of the clinical team. Provides oversight of assigned tasks and contracts, ensuring contract specifications are understood, tasks are assigned appropriately.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Leads the overall direction of the clinical team including pharmacists, nurses, and/or SMEs. Directly supervises managers and/or leads.
• Manages the day-to-day operations of assigned projects, as well as inter-project and cross-setting coordination of resources among projects; and contracts including facilitation and communication of resolution of barriers.
• Provides direction and support to other clinical staff as assigned.
• Prioritizes, delegates, and accomplishes tasks and programs independently and in a team to ensure successful implementation of goals and objectives.
• Works with the appropriate stakeholders, drug plans, prescribers, and pharmacies within the pharmacy community to: build partnerships, support data sharing, develop tools and references to support changes in care practices in the pharmacy arena.
• Reviews and interprets contract deliverables to ensure timely and accurate completion.
• Leads the design and application of work plans, as well as coordinating their evaluation and any needed modifications to ensure they reflect project work.
• Contributes to the conceptual design and implementation of projects, as well as assist with project execution as needed.
• Develops and responsible for implementing policies, procedures, work instructions, job aids, and other materials to ensure compliance with contract and industry practices.
• Ensures all project deliverables and timelines are met and reports on variances in a timely manner
• Provides direction and subject matter expertise to both self and desk audits.
• Initiates and contributes to the conceptual design, methodologies, and implementation of audits and projects, as well as assist with project execution as needed.
• Works closely with the client, plan sponsors, and pharmacy benefit managers to provide advice and expertise in Medicare Parts C and D associated with audits, policies, regulations, guidance documents, and correspondence.
• May provide educational programs as necessary to meet project goals and promote high quality, safe, and effective medication use.
• May contribute newsletter articles applicable to project goals and community needs/requests; contributes abstracts for submission to national pharmacy, medical, and quality organizations; submit written manuscripts, as appropriate, to pharmacy, medical, and quality care journals for publication.
• May contribute professional presentations at national pharmacy, medical, and quality organization meetings.
  
  

Required Skills

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

• Analytical - Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data; Designs work flows and procedures.
• Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations.
• Project Management - Develops project plans; Coordinates projects; Communicates changes and progress; Completes projects on time and budget; Manages project team activities.
• Leadership - Inspires and motivates others to perform well; effectively influences actions and opinions of others.
• Change Management - Develops workable implementation plans; Communicates changes effectively; Builds commitment and overcomes resistance; Prepares and supports those affected by change; Monitors transition and evaluates results
• Customer Service - Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
• Managing People - Includes staff in planning, decision-making, facilitating and process improvement; Takes responsibility for subordinates' activities; Makes self available to staff; Provides regular performance feedback; Develops subordinates' skills and encourages growth; Solicits and applies customer feedback (internal and external); Fosters quality focus in others; Improves processes, products and services.; Continually works to improve supervisory skills.
• Quality Management - Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness.
• Business Acumen - Business savvy; Understands business implications of decisions; Aligns work with company strategic goals. Maintains external strategic alliances in the pharmacy field.
• Judgment - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.
• Planning/Organizing - Sets goals and objectives aligned with strategic objectives; communicates this vision; Develops realistic action plans and workable implementation plans; and monitors progress.
• Delegation - As applicable, delegates work assignments; Matches the responsibility to the person; Gives authority to work independently; Sets expectations and monitors delegated activities.
• Organizational - Organizes resources and manages competing priorities to achieve competing priorities with ability to track multiple projects through time. Takes mitigating steps when required and plans for additional resources.
• Communication Skills - Ability to communicate effectively in written and verbal formats to a wide variety of parties internal and external to the organization. Ability to present and facilitate large and small groups. Communicates in a timely manner.
  
  

Qualifications

Required Experience

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education And/or Experience

• Active, current and non-restricted Pharmacist license in the areas required by the contract.
• Registered pharmacist, Bachelor’s degree in pharmacy, Master's degree in pharmacy or PharmD. Degree
• At least five years’ experience in practice (retail, health-systems, consulting, industry or academia) to include at least two years experience in a supervisory or senior role.
• Strong knowledge of the Medicare Parts C and D law, rules, and regulations, U.S. Food and Drug Administration law, rules and regulations; Drug Enforcement Administration law, rules and regulations; National Drug Codes; pharmacy benefit managers; the drug supply chain; clinical reviews; drug invoice reconciliation reviews; on-site pharmacy audits; drug compendia; First Databank; Medi-Span; HCIdea; and National Council of Prescription Drug Programs.
  
  

Language Skills

• Ability to read, analyze, and interpret common scientific and technical journals and legal documents.
• Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community.
• Ability to effectively create and present information.
  
  

Mathematical Skills

• Ability to calculate, apply, and interpret mathematical concepts including but not limited to averages, percentages, frequency distributions, ratios, and percentiles.
  
  

Reasoning Ability

• Ability to define problems, collect data, establish facts, and draw valid conclusions.
• Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
  
  

Computer Skills

• To perform this job successfully, an individual should have knowledge of Spreadsheet software, Presentation software and Word Processing software; knowledge of Project Management software preferred.
  
  

Other Skills And Abilities

• Ability to work independently with appropriate coordination among project staff, partners and customers.
• Strong project management experience.
• Highly organized, able to work in a fast-paced environment, able to juggle multiple projects and assign proper priority, able to switch among tasks quickly and calmly.
• Excellent interpersonal skills and ability to work with and through people to get the job done.
• Assertive and diplomatic; able to establish credibility very quickly.
• Ability to develop and maintain long term working relationships.
• Accurate, thorough, detail oriented with excellent follow-through.
• Travel Requirements- Local travel requiring use of personal vehicle; infrequently (less than 10%) overnight travel.
  
  

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