CarepathRx is seeking a Subject Matter Expert (SME) specializing in Specialty Pharmacy Operations. This role is essential in transforming hospital pharmacy operations from cost centers into revenue-generating entities by leveraging technology and market-leading pharmacy services. As part of CarepathRx, a company recognized for its innovation in pharmacy services, the SME will work to build, optimize, and scale high-performing specialty pharmacy programs.
Responsibilities
The SME will have a range of responsibilities, reflecting a blend of operational expertise and strategic guidance.
Operational Expertise & Education
Act as an expert resource for both internal teams and external clients regarding specialty pharmacy operations.
Educate teams and clients on essential accreditation requirements and compliance best practices, including URAC and ACHC standards.
Train teams on critical patient management workflows, which encompass financial assistance, prior authorization processes, and ongoing clinical support for patients.
Revenue Cycle & Business Performance
Provide insights on revenue cycle management processes focused on claims submission, denial management, and strategies to prioritize payment optimization.
Design and recommend methods to enhance financial outcomes by minimally leaking revenue and improving overall reimbursement strategies.
Advise on the creation and management of performance metrics and reporting frameworks to track progress efficiently.
340B & Payer Strategy
Offer expertise in capturing 340B contracts, compliance aspects, and efficient operational models.
Develop and support engagement strategies for both payers and manufacturers that align with reimbursement goals and specialty therapy access.
Strategic & Commercial Support
Collaborate closely with product management and commercial teams to define unique service offerings and value propositions.
Contribute to go-to-market strategies for newly launched products and services in the specialty pharmacy space, ensuring they meet market needs.
Engage in client presentations and proposal development as a key subject matter expert.
Qualifications
The role demands a combination of experience and education:
Experience: Candidates must have a minimum of 8-10 years in leadership roles focusing on specialty pharmacy operations, with experience in both payers and providers.
Education: A Bachelor's degree in Pharmacy, Healthcare Administration, or a related field is required, with a PharmD or MBA being preferred.
Required Expertise and Skills
Profound understanding of accreditation standards (URAC, ACHC) and managing patient access programs, including benefits verification and prior authorizations.
Strong grasp of revenue cycle management processes and financial performance optimization.
Familiarity with the operations of the 340B program is crucial.
Excellent communication and presentation capabilities are essential for effectively translating complex operational issues into practical solutions.
Candidates should be adept at using specialty pharmacy management software, data analytics platforms, and tools like Salesforce.com.
Salary and Benefits
While specific salary details are not provided in the job description, CarepathRx offers a comprehensive benefits package for full-time employees that includes:
Medical, dental, and vision coverage effective the first of the month following the date of hire.
401(k) retirement savings plan, flexible spending accounts, and company-paid life insurance.
Additional benefits include paid time off, paid holidays, and short-term disability coverage.
Additional Information
CarepathRx represents an environment that ensures equal employment opportunities for all applicants, irrespective of race, gender, sexual orientation, or other protected classifications. They encourage applicants to self-identify confidentially during the application process and maintain a drug-free workplace.
Local applicants are especially encouraged to apply, and all applicants must be eligible to work within the United States.
In summary, this position is not just a job but a pivotal role within CarepathRx that seeks seasoned professionals poised to leverage their knowledge for enhancing pharmacy services across healthcare. Candidates with strong operational experience, strategic vision, and a desire to make a significant impact in specialty pharmacy should consider this full-time opportunity.
This job offer was originally published on himalayas.app
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