UNITE HERE HEALTH

Director

• Manage Prescription Drug Programs: Oversee the development, negotiation, and implementation of pharmacy benefit management programs for health plans and employers.
• Provides leadership and has accountability for the performance and results of The Culinary Health Fund’s PBM and retail pharmacies
• Develops and monitors the pharmacy clinical policies and programs, where appropriate
• Leads the development of innovative clinical solutions to help manage the cost of the Fund’s pharmacy benefits, including but not limited to medication therapy management services for high-risk and general populations
• Leads the creation, maintenance, and enhancement of formularies for a variety of patient populations while working with lead clinicians and designated committees
• Ensures the success of Pharmacy Utilization Management, Prior Authorization, and other controls for all managed populations
• Negotiate Contracts: Work with pharmacies and pharmaceutical manufacturers to secure cost-effective medication options and manage rebate contracts.
• Data Analysis: Analyze drug utilization data to inform formulary strategies and ensure appropriate medication use.
• Analyzing pharmacy claims data to monitor drug spend and forecast trends
• Develops, implements, and ensures continuous quality and process improvement to deliver effective and efficient programs and services
• Regulatory Compliance: Ensure adherence to state and federal regulations regarding pharmacy benefits and prescription drug programs.
• Develops, maintains, and oversees local, state, and national regulatory compliance for all PBM services
• Provides oversight to ensure successful outcome of compliance audits/reviews (e.g., URAC)
• Relationship Management: Maintain relationships with pharmacies, healthcare providers, and other stakeholders to facilitate effective communication and service delivery.
• Collaborates with the Fund’s departments, Regional Directors and external stakeholders on service delivery including development and implementation of a network of community pharmacies to support broader healthcare delivery programs and to resolve claim issues
• Accountable for the performance of the various vendors engaged by the PBM for Pharmacy programs, analytical services and resolves issues affecting the service or financial objectives of the PBM
• Facilitates communication with network pharmacies
• Cost Management: Identifying cost-saving opportunities and developing strategies to reduce expenses.
• Provides leadership oversight for the assessment of value-based pharmacy programs to continually enhance the pharmacy programs

Director of Pharmacy

Call Center Representative

• Provides quality service by answering patients’ direct questions, and coordinating with the appropriate resources and/or departments
• Confirms patient eligibility, and answers eligibility related questions
• Assists with health center medical records
• Assists with health center referral coordination
• Assists with patient wellness class follow-up calls as needed
• Reviews appointment date, time, location, and provider name with patient
• Assists with all non-clinical inquiries and directs patient calls to all relevant locations within the health centers or to an outside source where applicable
• Provides benefit plan and eligibility information to patients, providers, unions, and employers
• Assists in escalating urgent, sensitive, or unresolved patient issues, concerns and/or inquiries
• Successfully participate in annual Mental Health call emergency training
• Assists with triaging Medical or Mental Health emergency calls
• Adheres to the Team Quality Assurance Program
• Establishes and maintains effective working relationships with all team members
• Assists with assigned special projects designated by Patient Contact Center Supervisor or Patient Contact Representative Lead

Director of Pharmacy

Patient Contact Center Representative