Summary

This position reports to the Assistant Director, Office of Behavioral Health. The Pharmacy Benefit Program Supervisor has responsibility for analyzing, developing, evaluating, and recommending action for the Behavioral Health Pharmacy Benefit Program and subcontracted services to ensure funds are contracted and expended efficiently to the desired effect of benefiting individual and families in Allegheny County. Overall responsibilities require an understanding of policies and procedures, guidelines and regulations governing the Allegheny County Department of Human Services Behavioral Health Pharmacy Benefit Program.

Essential Duties and Responsibilities

Duties include prescription pricing review and program utilization review.

The Supervisor will gather information from various resources and prepare reports requested by management.

Position entails monitoring provider programs, pharmacies, and the pharmacy benefit manager (PBM).

Monitoring will include reviewing claims, billing and management reports. The Pharmacy Benefit Program Supervisor maintains accurate and timely reports on pending and closed projects and reports.

The Supervisor will proactively seek and provide timely answers to questions coming from providers, staff, pharmacists, service users, and others using or inquiring about the program.

The Supervisor is also responsible for evaluating the practices of the BH Pharmacy Benefit Program and recommending program improvements while ensuring compliance with all applicable government regulatory standards and Allegheny County policies.

The Supervisor also will carry out daily program duties, such as ensuring eligibility status of service users prior to entering the Determination of Maximum Liability Form 878 into the PBM system.

The Supervisor is responsible for training of and directing the day-to-day activities of the Pharmacy Benefit Program Specialists.

Eligibility Maintenance

• Analyzes and evaluates eligibility status of consumers prior to the Pharmacy Specialist entering the Determination of Maximum Liability Form 878 into PBM’s online system. This encompasses the following:
  • Registering consumers
  • Reviewing the forms to ensure the information is complete and accurate
  • Acting to manage and resolve crises from pharmacists, the PBM representative, provider representatives and consumers.
  • Giving approval and recommending direction to the Pharmacy Specialist when a special condition to a consumer’s eligibility status applies.
• Ensures ongoing coverage for this function, which requires scheduling coordination for vacation, personal time, etc.
• Suggests to supervisors needed development or changes.

PBM Monitoring

• Develops recommendations from the statistical data, results comparisons and cost effectiveness of the program. Prepares the information, data analyses, evaluations and recommendations for reports and presentations.
• Assists with preparation or prepares data for reporting and decision making.
• Analyzes data and information from OptumRx, develops and calculates necessary information and data.
• Assists the Pharmacy Specialist with formatting, reviewing, verification and reconcilement process for bi-monthly billing reports prepared by OptumRx detailing the claim processing history for pharmacy service providers and consumers.
• Suggests to superiors needed development of changes.

Policies and Procedures

• Provides un-reviewed decisions and answers to policy and technical questions submitted by internal and external sources. Designs and communicates to agencies the requirements for the Pharmacy Benefit Program.
• Trains subordinate staff and external agencies on the program.
• Develops and revises polices and procedures for the Allegheny County MH DHS/OBH Pharmacy Benefit Program.
• Analyzes and evaluates new guidelines and/or changes to existing guidelines when proposed.

Coordination of PBM Services

• Develops and analyzes information to facilitate the drafting of agreements and request for proposals.
• Ensures that updates of the Prescription Form 12s are sent to OptumRx.
• Suggest to superiors needed development or changes.

Training

• Trains subordinate staff and external agencies on the OBH Pharmacy Benefit Program.
• Responsible for preparing correspondence and manuals for training purposes.
• Maintains and disseminates educational materials used in the training process and updates the material to reflect current applications, including the maintenance of written plans and procedures.

Supervisory Responsibilities

• Supervisory responsibilities over the subordinate staff.
• Provides general direction and leadership for all aspects of the program to maintain efficient operation.
• Collaborates with upper management on a regular basis in setting strategic goals/objectives, and/or fostering improvements in polices/procedures for the program.
• Responsible for developing and motivating staff to accomplish established objectives.
• Maintains and nurtures effective communication and partnerships with staff, peers and outside agencies contracting with the program.
• Assigns work to subordinate staff and issues special instructions for non-routine or complex assignments. Directs parameters of and determines procedures for activities of subordinates. Approves ordinary time off for vacations, personal time off and sick time.
• Provides technical assistance to contractors and subordinates. Review, accepts and amends findings, analyses and other work of subordinates. Writes job descriptions, sets standards for and conducts performance evaluations for subordinates. Holds corrective action interviews with subordinates. Participates in staff recruitment and selection.
• Responsible for ordering Prescription Form 12s.

Additional Responsibilities

From time to time the employee will be required to perform additional tasks and duties as required by the employer.

Knowledge, Skills and Abilities

• Comprehensive knowledge and understanding of the policies, procedures and regulations governing the Allegheny County Department of Human Services, Office of Behavioral Health BH Pharmacy Benefit Program.
• Ability to operate current computer systems, including relevant software packages.
• Ability to provide direction and guidance to staff.
• Ability to schedule, train, supervise, assign work to and evaluate staff.
• Leadership, coaching and teambuilding skills to strengthen and cultivate relationships.
• Strategic and analytical thinking skills with an ability to solve problems and make decisions.
• Ability to network and interact, as well as support effective partnerships with key groups and individuals.
• Ability to prioritize ongoing and new projects, as well as conduct research and gather information.
• High level of skill in communicating efficiently and effectively both orally and in writing with a variety of internal and external individuals or agency representatives.
• Skill in continuously seeking to improve the quality of services and processes.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above 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, consistent with applicable law.

Education/Experience Requirements

Bachelor’s degree, in a health related field, plus at least two years experience in a health program/field, along with a working knowledge of spreadsheets and data analysis and one year experience as a Pharmacy Specialist with experience with personnel administration, financial management, program planning and coordination and administrable functions.

-OR-

Equivalent experiences with psychiatric medication benefit program(s).

-OR-

Any equivalent combination of education and experience that meets the required knowledge, skills and abilities.

Certificates, Licenses, Registrations

Act 33 & 34 clearances.