What you’ll do

In a few words…

Abarca is igniting a revolution in healthcare. We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…

The Pharmacy Benefit Manager (PBM) Operations and Services team provides high quality services to clients and members by leading services from clinical programs, pricing, eligibility, configurations, and beneficiary services to government services and beyond. Our Clinical Services team is focused on helping our members get the pharmacy care they need. Our clinicians develop outcome driven clinical programs ensuring the quality of services is provided, develop comprehensive clinical coverage criteria and most importantly we have our clinical teams focus on clinical outreach programs to members, physicians, and pharmacies.

As AVP, Clinical Services, you will be responsible for planning and creating the ongoing strategic, operational, and service design to achieve the mission and vision of Abarca’s clinical and operational leadership. This position provides high-performance leadership to the clinical services team and serves as a lead pharmacy executive representing Abarca. The AVP, Clinical Services will work cross functionally to direct, develop, drive, implement, and maintain clinical pharmacy programs that integrate medical and pharmacy drug initiatives to improve clinical effectiveness and lower overall medical and drug costs. The leader of clinical services will be responsible for thought leadership in clinical innovation to create and improve key quality and delivery clinical programs.

The fundamentals for the job…

Build, inspire, and engage a high-performance clinical team that is focused on delivering clinical value to members and clients.
Collaborate with key internal stakeholders, especially the Pharmacy Benefit Manager Operations and Drug Value Strategy (DVS) leaders, to drive the idea generation for improved delivery of clinical interventions to members and pharmacies.
Create clinical initiative project plans that highlight key deliverables focused on meeting or exceeding clinical and quality client commitments.
Design, build and deliver the clinical strategy with new and existing programs and solutions to enhance the value to our clients.
Establish a level of accountability for division’s strategic performance and quality goals, defining Objective, Key Results (OKR's) and key performance indicators.
Lead cross functional initiatives working with Product teams to develop a clinical product roadmap that is aligned to the clinical service strategy with the goal of providing a better experience to members and a more efficient workflow for the clinical team.
Responsible for clinical account managers (CAM) performance and deliverables to our clients and key stakeholders (i.e. client success). Key deliverables to clients include drug trend reporting, cost savings initiatives, and clinical and operational insights to improve our clients drug spend and meet regulatory requirements.
Develop resource library for clinical account managers (CAM) including but not limited to reports and tools from DVS team, third party subscriptions and resources, and standard and ad-hoc reporting library.
Responsible for the development of the clinical and financial value of clinical programs and initiatives including outcomes.
Oversee daily operations of clinical service teams which will include disease state management, academic detailing, drug information, coverage determination and quality programs initiatives.
Responsible for ensuring Pharmacy & Therapeutics (P&T) committee is promoting the appropriate use of high quality and cost-effective pharmaceutical utilizing clinical best practices and unbiased, evidence-based information.
Actively participates in Abarca P&T Committee meetings and client P&T meetings as per client contract.
Engage in periodic consultation with practitioners in the field, and members of the Pharmacy and Therapeutics Committee (P&T)
You are accountable for decisions made by qualified clinicians which affect Members.
Coach, mentor, and develop staff, including overseeing new employee onboarding and providing growth and development.
Serve as member of the company’s Operational Performance and Quality Management Committee to promote, oversee, and evaluate quality management activities.
Oversees a division’s process improvement and any special initiatives.
Oversee all decision-making aspects of clinical services and programs ensuring compliance with all applicable laws, regulations, policies and procedures.
Understand and remain informed of utilization and quality management techniques, market and industry drug trends, and issues in the healthcare industry to effectively and cost efficiently develop and implement strategies to improve health outcomes.
Support and oversee medication safety-related activities, such as Abarca’s Medication Error Identifications and Reduction Program, Consumer Safety Committee, drug recalls and shortages, drug safety notifications.
Support the Business Development in request for proposal (RFPs), demos, and development of proposals related to clinical services.
Support the tech division with clinical expertise.
Support SSAE 16 initiatives.
Other projects or duties as needed.

What you’re made of

The bold requirements…

Doctoral Degree in Pharmacy is required.
Current and Active Pharmacy License is required.
12+ years of clinical experience, including 6+ years of experience leading teams.
Experience with pharmacy benefit management clinical operations and Medicare Part D.
Experience with dashboard tools, such as Power BI and Excel tools.
Experience with handling multiple projects at once in collaboration with internal and external stakeholders.
Excellent verbal and written communication skills.
We are proud to offer a flexible hybrid work model which will require certain on-site workdays (Puerto Rico Location Only).

Physical requirements…

Must be able to access and navigate each department at the organization’s facilities.
Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify. “Applicant must be a United States’ citizen. Abarca Health LLC does not sponsor employment visas at this time”

All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of gender, race/ethnicity, gender identity, sexual orientation, protected veteran status, disability, or other protected group status.

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