Manager, Pharmacy Compliance - Pharmacy

Manager, BH 340B Pharmacy Compliance- Baystate Medical Center- Pharmacy

Baystate Health Careers

Department: Pharmacy Compliace

Location: Baystate Medical Center, Springfield MA

Job Type: Salary, full time

Make an Impact with Baystate Health

Baystate Health is seeking a Manager of BH340B to join our Pharmacy Compliance Team at Baystate Medical Center in Springfield, Massachusetts.

Schedule Details

• Job Type:  Full time
• Hours: 40
• Schedule: Days

Required Work Experience:

•  7+ years DSH/340B program experience

Required Education:

• Bachelors Degree
  
  

Summary:

The BH Manager, 340B Pharmacy Compliance, is responsible for the compliance and administration of the Federal 340B Drug Pricing Program for all qualified entities throughout Baystate Health. The BH Manager is the institutional compliance expert and authority on 340B Program details and oversees all 340B Program Services. The BH Manager is the primary 340B Program contact, HRSA Primary Contact and liaison for all 340B subject matters.

This position manages regulatory adherence, develops all 340 B-related policies and procedures, and is responsible for the accuracy of the HRSA OPAIS Database.

The BH Manager is responsible for all Third Party Administrator oversight.

The BH Manager engages with leadership and participates in decision-making processes related to the 340B Program. The BH Manager leads the BH Executive Oversight Committee (for 340B) activities. The BH Manager is an integral leader reporting directly to the BH Director, Pharmacy Business Operations.

The BH Manager identifies and leads BH-wide financial process change opportunities at relevant hospital-based and clinical practice locations, while balancing compliance and savings maximization. The BH Manager performs continual audits of the ambulatory pharmacies and the hospital mixed-use areas to validate compliance with the Federal 340B program regulations and assure program optimization. 

The BH Manager is responsible for training, auditing, monitoring systems, and establishing & implementing corrective action plans. The BH Manager maintains audit files, prepares reports, communicates results and continually makes recommendations for improvement.  The BH Manager uses their in-depth knowledge of the 340B program and third-party-administration systems to push analytics that support optimization strategies focused on the growth of the 340B program.

Job Responsibilities:

1) Responsible for all points of service where 340B Drug Pricing Program participation occurs to ensure policies and procedures are followed accordingly and is accountable for being the institutional program expert about plan qualifications, policies, and procedures. Develop and implement a continual compliance plan so that evolving risks are addressed and resolved in a timely manner.  Monitors access to pharmacy information systems to ensure proper controls are in place.

2)  Manages a team of auditors and compliance analysts focused on performing routine, random, and targeted drug ordering, receiving, and dispensing audits for hospitals, ambulatory, and contract pharmacies. Serves as the primary contact for effectively reporting audit results and variances through appropriate channels.

3) Administered all third-party pharmacy administrative systems, including Macrohelix and CVS/WellPartner.

4) Maintains knowledge of the policy changes that affect the 340B Program, including, but not limited to, HRSA/OPA rules and Medicaid changes and audit requirements, and ensures BH policies, processes, and procedures reflect those programmatic requirements.  Responsible for ensuring that the HRSA 340B OPAIS Database is accurate for all system-covered entities and the annual HRSA recertification is completed.  Serves as the primary contact for the government (HRSA) audit of the DSH 340B program.  Understands the intricate relationship between pharmacy transactions and systems. Coordinates external compliance assessments with outside firms, where appropriate, to validate internal processes.

4) Assesses risk, makes recommendations, establishes and implements corrective action plans to minimize/eliminate risk, and improves and sustains program compliance in collaboration with BH corporate compliance and BH legal counsel.

5) Develops and maintains internal and external relationships (legal, compliance, revenue advisory) as needed, as well as internal relationships (wholesalers, manufacturers, contract pharmacies, and split-billing software vendors).

6) Partner with the BH Director to facilitate pharmacy contract negotiations and GPO/PVP relationships.

7) Responsible for representing the BH 340B program when working with drug manufacturers and government oversight organizations to resolve 340B discrepancies.

8) Collaborates to ensure accuracy and integrity in all drug price files, provider files, software interfaces, and payor schedules. Continually review purchasing optimization methods. Ensures efficient procurement of all drugs and related medical supplies.

9) Responsible for 340B automation and system integration across multiple platforms. Monitors access to multiple pharmacy information systems to ensure proper controls are in place and ensure HIPPA and 340B compliance. Integrates data files from various systems and vendors into automated workflows. Collaborates with I&T teams on the use of artificial intelligence software.

10) Attends and presents at relevant DSH/340B external conferences, seminars, and internal meetings to ensure new knowledge is shared and compliance risks are minimized or removed.  Routinely monitors industry publications, media and literature to ensure that BH has the latest information regarding interpretations, government rulings, suggestions, and advanced ideas for improving participation.

11) Leads the BH 340B Executive Oversight Committee. Responsible for creating agendas and developing monthly, quarterly and yearly audit metrics.

Manages a team of compliance analysts to optimize and maintain 340B compliance across all BH Covered Entities.

12) Responsible for training and educating 340B compliance analysts and all related HR activities.

13) Facilitates, organizes, and leads ‘340B Leaders’ meetings for the eastern region.

Required Experience:

7+ years DSH/340B program experience

Preferred Experience:

10+ years DSH/340B program experience

Skills/Competencies:

Proficiency in Excel, Word, Outlook, and other applications is required.

In-depth understanding of the Federal DSH/340B drug pricing program administered by HRSA/OPA.

Excellent knowledge of drug brands, generic names, uses doses, and dosage forms/package sizes.

Understanding of retail and hospital pharmacy financial and business processes.

Familiarity with compliance/auditing concepts.

Ability to quickly learn new technologies and computer software programs required.

Ability to provide targeted communication, both verbal and written.

Proven analytical & process redesign skills, including problem-solving, quantitative reasoning, workflow process, etc.

Ability to navigate challenging conversations and deal calmly but firmly with sensitive matters.

Ability to maintain strict confidentiality of employee, patient, and organizational information.

Education:

Bachelors Degree (Required)

Certifications:

Compensation

Note: The compensation range(s) in the table below represent the base salaries for all positions at a given grade across the health system. Typically, a new hire can expect a starting salary somewhere in the lower part of the range. Actual salaries may vary by position and will be determined based on the candidate's relevant experience. No employee will be paid below the minimum of the range. Pay ranges are listed as hourly for non-exempt employees and based on assumed full time commitment for exempt employees.

Minimum - Midpoint - Maximum

$118,934.00 - $136,718.00 - $161,720.00

Equal Employment Opportunity Employer