Program Manager

JOB SUMMARY

340B Manager works in collaboration with and oversees Pharmacy and 340B Program Analyst on a variety of functions including 340B self-audits, inventory management duties, evaluation of pharmaceutical billing / reimbursement practices to ensure compliance with laws and regulations.

Also works as a part of the pharmacy leadership team on initiatives to improve pharmacy services and compliance.

ESSENTIAL JOB DUTIES

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Oversees 340B Program Audits - 10%
• Oversees and assist as needed in all 340B Program audits.
• Creates and manages an audit schedule and tracker to ensure timely and accurate completion of all 340B related audits, including but not limited to : contract pharmacy, in-house pharmacy, clinic-administered medications, Medicaid compliance, etc.
• Ensures resolution of all 340B audit findings
• Ensures compliance with 340B Program requirements for qualified patients, drugs, and locations.
• Uses independent judgement to decide outcome of audit (pass / fail) and makes appropriate corrections to fix any failing audits.

Reports results to leadership.

• Ensures that organization maintains adherence to 340B Program regulations and guidelines.
• Develop and foster working relationships with internal working counterparts (IT, clinical staff, and others) to facilitate productive exchanges of information to improve program efficiency and promote program compliance.
• Provide data, information, and reports as needed for other business units within the organization.
• Develop systems and processes to limit program liabilities and provide proper audits to identify risk and prevent duplicate discounts and diversion.
• Review 340B Program policies and procedures on an ongoing basis and offer contributions and suggestions to ensure 340B compliance.
• 340B Referral Capture - 25%
• Manages GLBHC 340B referrals by utilizing various 340B software systems, and verifying appropriate documentation is in place to capture referral prescriptions for contract and in house pharmacies.
• Audits In-house pharmacy referrals to ensure appropriate documentation in place. If any documents are missing or incomplete, take appropriate steps to correct.
• 340B Education - 5%
• Maintain & expand professional development through related classes and seminars, current publications, and regional / national association membership participation.
• Provide education to staff as needed on policies and procedures related to 340B.
• Pharmaceutical Inventory Management - 15%
• Coordinates all pharmaceutical ordering for all GLBHC clinic sites
• Monitors inventory levels at GLBHC sites and works with clinic leadership to set appropriate levels, monitor usage and waste.
• Monitors wholesaler price catalogs to analyze best prices and make changes to optimize drug spend for clinics and in house pharmacies as needed
• Ensures all purchases are compliant with DSCSA regulations as necessary
• Travel to sites within GLBHC to provide training and education on 340B and inventory management as needed to ensure compliance or improve processes.
• Pharmacy special projects & initiatives - 5%
• Identifies areas for opportunity in pharmacy service areas and helps create and implement solutions
• Assists pharmacy leadership with special projects, audits, implementations, etc.
• Pharmacy Billing / Reimbursement review - 10%
• Oversees the completion of review of claims for pharmaceutical products to ensure compliance with laws and regulations
• Includes checking for items such as : proper codes and modifiers, billing quantities, 340B eligibility, actual acquisition costs, NDCs, and any other item that is required for compliance with 340B and Medicaid / Medicare.
• Assists 340B Assistant Director in review of billing practices for pharmacy products to ensure compliance with laws and regulations
• Reporting - 10%
• Manages the submission of data reports to 340B ESP and other vendors as needed
• Analyzes findings from reports to identify and correct issues
• Create reports to effectively communicate audit findings, systemic issues, and solutions / resolutions.
• Manages record retention for compliance and audit purposes.
• Collaborate with the pharmacy leadership and 340B Oversight Committee to develop monthly, quarterly, and yearly metrics and key performance indicators.
• Third-Party Administrator and Pharmacy Software Duties - 20%
• Manage the process of keeping TPA systems up to date, including but not limited to manufacturer block lists, prescriber lists, and Medicaid plan listings.
• Frequently monitors 340B software systems to identify potential problems.
• Reviewing, interpreting and analyzing the data to ensure utilization of software systems available to fullest potential to ensure compliance with 340B program guidance.
• Develop a thorough understanding all third-party administrator systems and the functions to be performed.
• Develop a thorough understanding of all pharmacy and inventory management systems in order to be able to complete assigned audits and tasks.

Note : This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for the job.

Duties, responsibilities and activities may change at any time with or without notice.

MARGINAL JOB DUTIES

• Performs other duties as assigned.
• Attend meetings as required / assigned.
• Travel to various GLBHC sites to assist in organizational or education activities.

JOB SPECIFICATIONS

Education : Associates degree or 2-4 of relevant experience. Recent and relevant healthcare experience required; pharmacy technician preferred.

340B University completion required within 90 days. 340B ACE certification preferred.

Licensure : None required, medical field licensure preferred

Experience : Previous pharmacy technician and / or medical setting experience preferred. Previous experience using Microsoft Excel required.

Skills : Basic computer skills, knowledge of and ability to use Microsoft Office Applications pharmacy program literacy preferred.

Able to type accurately at 35 wpm. Knowledge of medication brands and generic names. Knowledge of insurance and third-party payment systems.

Must have excellent attention to detail. Must be able to multi-task efficiently and effectively. Understanding of medical terminology and calculations.

Ability to follow oral and written instructions. Must be a self-starter and have ability to work independently and remain on task.

Interpersonal Skills : Strong organizational skills. Strong interpersonal and communication skills including the ability to effectively communication with a diverse population.

Professional and courteous attitude. Ability to tolerate repetitive work tasks. Professional respect for patient's rights to confidentiality.

Physical Effort : Must be able to sit, stand, and or walk for an entire workday. Must be able to lift, carry, push, pull, and or twist while holding up to 25 lbs. frequently.

Hours of Work : Full Time 40 hours weekly average. Must maintain regular and timely attendance. Partial Remote work

Travel : Local travel between sites as necessary on a regular basis. Reimbursement for expenses provided according to existing rates as established by GLBHC policy.

Must be a licensed driver with proof of personal liability and property damage insurance.

GLBHC is an equal opportunity employer and prohibits discrimination and or harassment based on race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, and or local laws.