Company Details:
Berkley Medical Management Solutions (BMMS) provides a different kind of managed-care service for W.R. Berkley Corporation. We believe focusing on an injured workers successful and speedy return to work is good for people and good for Berkleys insurance operating units. BMMS was first started in 2014 by reimagining the relationship between medical need and technology as a way to deliver the best outcome for injured workers and Berkleys operating units. Our goal was clear: combine solid clinical practices, proven return-to-work strategies and robust software into one system for seamless management of workers compensation cases.
To get it right, we started with a flexible technology platform that allowed for impressive customization without sacrificing the ability for expansion and continued innovation. We deploy integrated systems to give W.R. Berkley Companies recommendations and professional services for managing each individual case in an efficient and appropriate manner. The power of our technology takes medical bill-review services and clinical advisory services to a new level. Our unique marriage of technology, software platforms, data analytics and professional services ensures we provide Berkleys operating units with reliable results, and reduced time and expenses associated with case management.
Responsibilities:
As the Director, Pharmacy Services you will provide guidance, analytics, insights and leadership to our clinical management team while serving as a liaison for clinical and pharmacy related programs, solutions, and with our pharmacy benefit manager. These interactions may involve our technology providers, pharmacy vendors, physician networks, informatics, internal and external partners or other industry organizations.
You will support clinically-related short term and long term operational, product and/or technical solutions and strategies through guiding development of, enhancements to improve end to end clinical process and systems decision making. Well also look to you to, in collaboration with internal partners, design and implementation of pharmacy solutions or internal business functions by providing clinically relevant research and analysis of pharmacy and related clinical data.
- Clinical data analysis to provide understanding and effectiveness of programs and claimant outcomes to internal and external stakeholders
- Clinical Program system support and usability
- Development of enhancements to current pharmacy and clinical programs
- Review of injured workers medications and suggestive measures as required
- Hold round tables with the clinical team, as well as the operating units
- Create and present monthly trend and comparison reports
- Create, review and update formularies on a regular basis
- Perform drug utilization evaluations, and medication reviews to drive improved outcomes and cost savings
- Interact with clinical team, as well as providers to leverage best practice initiatives
- Research and identify state and federal changes, additions and deletions of medication
- Interaction with and management of our external pharmacy partner relationship
- Liaison between external pharmacy partner and internal stakeholders and clinical management team
- Work with our pharmacy benefit manager to leverage information and data insuring proper clinical decision making
- Review of individual high-risk claimants
- Development of pharmacy trend reporting for management in conjunction with our pharmacy benefit manager
- Educate internal and external peers and colleagues on clinical and pharmacy concerns, issues or trends
- Drive best-practice adoption across the organization as it relates to pharmacy practice to achieve the best outcomes for claimants served
- Anticipates customer needs and proactively develops solutions to meet them
- Serves as a key resource on complex and/or critical issues and claims.
- Solves complex problems and develops innovative solutions.
Qualifications:
- Possess a current Clinical and/or Pharmacy license
- 5+ years of clinical leadership and program management or account management experience
- 5+ years of direct patient clinical experience
- Strong influencer with demonstrated skills in innovative thinking
- Proven experience leading and managing change initiatives
- Expert understanding of the clinical process and data integrity requirements using technology
- Strong process improvement skills / experience
- Strong interpersonal, communication and relationship building skills across multiple audiences
- Strong data analytic and problem-solving skills
- Proficient with MS Office Suite: Excel, Word, PowerPoint, Outlook, Project and Visio
- Ability to hold individuals accountable and develop the ability to influence without authority
- Ability to act as a clinical technology consultant to product, operations and technology partners
Education
- Degree in pharmacy or related healthcare field from an accredited program/college/university
- This position requires a professional clinical degree or license with a heavy preference on a pharmacy or pharmaceutical science degree.
Travel Requirements
- Domestic U.S. travel required
Additional Company Details: www.berkleymms.com The Company is an equal employment opportunity employer We do not accept any unsolicited resumes from external recruiting agencies or firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.