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MaineCare Associate Director of Pharmacy

Augusta , Maine , United States | Management & Supervisory | Full-time

Apply by: March 5, 2025

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Department of Health and Human Services (DHHS)Public Service Manager IIIOpening Date:February 12, 2025Closing Date: March 5, 2025Job Class Code:MA34 (Confidential)Grade:34Salary:$84,697.60 - $120,265.60 per yearPosition Number:02000-2939Location: Augusta

Core Responsibilities:

As MaineCare’s Associate Director of Pharmacy, you will advise on coverage and the development and implementation of pharmacy strategy relating to utilization management, reimbursement, and drug rebate management for both point-of-sale retail and medical (i.e. physician-administered drugs) pharmacy benefits. You will oversee the Pharmacy Benefit Administrator (PBA) and associated contract (worth $29 million), which includes the operation of MEPOPS and the associated long-term procurement strategy for these services. You will serve as a member of the OMS Senior Management Team (SMT) to advise the MaineCare Director and share in decision-making and leadership of MaineCare programs, services, and operations. You will report to the MaineCare Director and will work under limited supervision. Your goals and duties will include:

• Provide leadership and management for the 11-member Pharmacy unit, ensure that the team is aligned with OMS and DHHS business needs and priorities and to set standards for effective and efficient program administration. Assign and monitor the work of direct reports to ensure that work is appropriately prioritized, scheduled, and executed by agreed-upon plans.

• Overseeing the current PBA contract, including holding the PBA vendor accountable for contract terms and effective use of state/federal resources to support members with appropriate, cost-effective, timely access to critical medications.

• Developing and implementing a PBA contract procurement strategy and timeline in alignment with federal regulations and standards, state procurement processes, and the broader MaineCare strategy for the Medicaid Enterprise System.

• Oversee an integrated approach to managing retail and medical pharmacy benefits, including utilization management initiatives such as a biosimilar preferred drug list, and strategies for managing requests for high cost drugs to ensure member access to necessary care and reduce cost exposure to the state to the extent possible.

• Planning and overseeing data collection, reporting, and program review and assessment to support efficient delivery of quality programs and services and compliance with applicable state and federal laws, regulations, policies, procedures, and performance standards.

• Collaborating with internal and external partners to navigate and gather feedback on complex policy and operational challenges, including pharmacies, hospitals, and other provider organizations; individual pharmacists and physicians; advocacy organizations; and legislators.

• Developing planning documents, briefs, and recommendations to implement clinically effective drug treatments and cost containment where appropriate.

• Overseeing the Drug Utilization Review (DUR) committee to improve member access to safe and cost-effective drug treatments.

• Evaluating operational processes for efficiency, effectiveness, and potential improvements.

• Managing the PBA’s provider and member complaint escalation to promote high-quality customer service.

• Implementing and tracking the progress of pharmacy-related legislation and budget initiatives.

• Managing and responding to all pharmacy-related audits.

• Working proactively with MaineCare’s policy unit on pharmacy-related policy development and implementation.

• Using sound judgment and strong problem-solving skills to provide direction and make decisions on escalated issues, questions, and decisions from the Pharmacy team.

• Professionally representing the team, office, and Department on pharmacy-related issues.

Minimum Qualifications:

To qualify, your background must include a 10-year combination of education and experience in pharmaceutical operations, pharmaceutical policy, health care administration, health care systems administration, or public policy, which provides significant related experience managing staff and ongoing operations. A current Pharmacist license and/or professional degree in public policy or administration, healthcare administration, business, or other comparable field focusing on health or pharmaceutical policy is preferred.

The background of preferred candidates will demonstrate the following competencies:

1. A proven ability to oversee and manage the performance of large vendor contracts or comparable experience.

2. A broad knowledge of pharmaceutical policy, including public health policy, health care policy, and pharmaceutical industrial policy, and the ability to stay current on emerging strategies and best practices.

3. Experience with and knowledge of the Medicaid program.

4. Strong interpersonal skills and the ability to build effective working relationships across internal and external teams and levels of staff.

5. Ability to research, comprehend, interpret, and synthesize complex data and other information into well-formed conclusions and recommendations and confidently advise other senior leaders accordingly.

6. Ability to communicate effectively verbally and in writing for multiple technical and non-technical audiences.

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Agency information:

TheDepartment of Health and Human Services (https://www.maine.gov/dhhs/) (DHHS) is dedicated to promoting health, safety, resilience, and opportunity for Maine people. The Department provides health and social services to approximately a third of the State's population, including children, families, older Mainers, and individuals with disabilities, mental illness, and substance use disorders. The Department also promotes public health, operates two state psychiatric hospitals, and provides oversight to health care providers.

The Office of MaineCare Services (OMS) within DHHS administers the state’s Medicaid program, which provides health insurance coverage for low-income families, adults, and children. OMS works collaboratively within DHHS, with other Departments and the Office of the Governor, and with other healthcare purchasers on statewide healthcare improvement initiatives. OMS is committed to advancing health equity efforts to improve access to care and health outcomes for all MaineCare members. OMS ensures that its coverage and the services it supports align with Department goals, federal mandates, and State policy. OMS also provides oversight necessary to ensure accountability and efficient and effective administration.

Retail pharmacy-related benefits administered by MaineCare total approximately $550 million and are available to approximately 400,000 Maine residents annually through Medicaid and an additional 75,000 through programs like MaineRx Plus and Maine Low-Cost Drug for the Elderly or Disabled (DEL). The Pharmacy Division includes 11 state and contracted staff who manage MEPOPS, the retail pharmacy point of sale claims system, operate MaineCare’s Pharmacy Help Desk for members, and run MaineCare’s drug rebate program, which brings in about $350 million a year.

Application Information:

Please submit all documents or files in PDF format.

For additional information about this position, please contact Michelle Probert, Director, at (207) 287-2093 or by e-mail at Michelle.Probert@Maine.gov

To request a paper application, please contact Mandy.Hernandez@Maine.gov

Benefits of working for the State of Maine:

No matter where you work across Maine state government, you find employees who embody our state motto—"Dirigo" or "I lead"—as they provide essential services to Mainers every day. We believe in supporting our workforce's health and wellbeing with a valuable total compensation package, including:

• Work-Life Fit – Rest is essential. Take time for yourself using 13 paid holidays , 12 days of sick leave , and 3+ weeks of vacation leave annually. Vacation leave accrual increases with years of service, and overtime-exempt employees receive personal leave.

• Health Insurance Coverage – The State of Maine pays 85%-95% of employee-only premiums ($11,196.96 - $12,514.32 annual value), depending on salary. Use this chart to find the premium costs for you and your family, including the percentage of dependent coverage paid by the State.

• Dental Insurance – The State of Maine pays 100% of employee-only dental premiums ($387.92 annual value).

• Retirement Plan – The State contributes the equivalent of 13.29% of the employee's pay towards the Maine Public Employees Retirement System (MainePERS).

• Parental leave is one of the most important benefits for any working parent. All employees who are welcoming a child—including fathers and adoptive parents—receivesix weeks of fully paid parental leave. Additional, unpaid leave may also be available, under the Family and Medical Leave Act (https://www.maine.gov/bhr/state-employees/workplace-posters) .

  State employees are eligible for an extensive and highly competitive benefits package (https://www.maine.gov/bhr/state-jobs/compensation-benefits) , covering many aspects of wellness. Learn about additional wellness benefits for State employees from the Office of Employee Health and Wellness (https://www.maine.gov/bhr/oeh/) .

  Note: Benefits may vary somewhat according to specific collective bargaining agreements and are prorated for anything less than full-time.

There's a job and then there's purposeful, transformative work. Our aim is to create a workplace where you can learn, grow, and continuously refine your skills. Applicants demonstrate job requirements in differing ways, and we appreciate that many skills and backgrounds can make people successful in this role.

As an Equal Opportunity employer, Maine State Government embraces a culture of respect and awareness. We are committed to creating a strong sense of belonging for all team members, and our process ensures an inclusive environment to applicants of all backgrounds including diverse race, color, sex, sexual orientation or gender identity, physical or mental disability, religion, age, ancestry, national origin, familial status or genetics.

If you’re looking for a great next step, and want to feel good about what you do, we’d love to hear from you. Please note reasonable accommodations are provided to qualified individuals with disabilities upon request.