Assistant Director of Pharmacy Operations (Revenue), Corporate Pharmacy

Empower Every New Yorker - Without Exception - to Live the Healthiest Life Possible

NYC Health + Hospitals is the largest public health care system in the United States. We provide essential outpatient, inpatient and home-based services to more than one million New Yorkers every year across the city's five boroughs. Our large health system consists of ambulatory centers, acute care centers, post-acute care/long-term care, rehabilitation programs, Home Care, and Correctional Health Services. Our diverse workforce is uniquely focused on empowering New Yorkers, without exception, to live the healthiest life possible.

At NYC Health + Hospitals, our mission is to deliver high quality care health services, without exception. Every employee takes a person-centered approach that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathic communication and partnerships between all persons.

Job Description

General tasks and responsibilities will include:

• Operations
  • Assist Enterprise Committees (Enterprise Pharmacy & Therapeutics, Pharmacy Operations, Clinical Councils, etc.) in initiatives by providing in-depth financial/value analyses
  • Monitor and assist in vendor contract review/assessments to ensure service levels are compliant, up to date and appropriate for the Health System
  • Monitors and reports on strategic, system-wide initiatives across the Health System including, but not limited to, all aspects of clinical and nonclinical pharmacy operations.
  • Support the implementation of operational and clinical pharmacy initiatives through liaising with hospitals, ancillary facilities, clinical departments, committees, nursing, medical staff, and other key stakeholder groups throughout the Health System's continuum of care.
  • Assists with coordinating comprehensive pharmacy services to include patient access to affordable pharmaceuticals and system applications that improve patient outcomes through safe and effective medication use.
  • Work with sites, managed care and other departments to decrease medication-related claim denials and outstanding claims
  • Provide education to site and system stakeholders to drive optimal revenue capture
  • Develop policies and/or guidelines to improve revenue integrity, capture and compliance
  • Develop quality metrics and audit methodologies to drive accuracy and quality for all HCPCS/CPT codes, revenue codes, billable units, multipliers, modifiers, indications, etc.
  • Actively research and stay current with important billing and revenue related compliance and optimization topics to guide appropriate organizational decisions
  • Participate and lead committees, work groups, process improvement efforts and educational initiatives to improve pharmacy revenue integrity and pharmacy billing cycle
  • Develop process improvement workflows, education and communication to improve pharmacy revenue integrity and compliance
  • Monitors and evaluates the impact of industry trends on the area's current business performance and competitive outlook.
  • Analyzes competitors' services and prices, synthesizes information, and develops a cohesive, integrated marketing strategy and action plan.
  • Ensures active communication with all external and internal constituencies to establish strong relationships that are complimentary and consistent with organizational goals and strategic needs.
  • Identifies new opportunities, tests new ideas and ensures implementation.
  • Identifies and manages performance improvement dependencies and critical path issues.
• Strategic Planning
  • Works with Sr. leadership to help initiate and develop the strategic plans, policies and procedures for areas of the business where applicable.
  • Helps develop and monitor new business initiatives and opportunities consistent with the mission and strategic direction of the Health System under the direction of Senior Leadership.
  • Measures organizational performance against goals and objectives. Ensures results are defined and measurable and are focused on growth, improving outcomes, clinical effectiveness and patient safety.
  • Participates in initiatives that increase our market advantage.
  • Measures metrics to implement management controls and reporting procedures to ensure that the department has up to date situational awareness of all core issues and operating data pertinent to sound decision making.
  • Helps to develop and monitor, system-wide initiatives across the Health System including, but not limited to, all aspects of clinical and nonclinical pharmacy operations.
• Financial Management
  • Monitors financial and capital expenditures by assessing profitability, alignment with business objectives and budget parameters.
  • Serve as a liaison between finance, revenue integrity, compliance, pharmacy and other departments to standardize and optimize pharmacy charging workflows, pharmacy revenue, business processes, billing, denial management, etc.
  • Participate in financial analyses of proposed changes to determine charge and revenue implications related to the pharmacy charge description master maintenance
  • Act as the system expert on medication-related compliance billing and charging topics
  • Helps manage financial and outcomes analyses, recommends improvements to Sr. leadership, and assists in implementing processes to reduce pharmaceutical costs while maintaining high levels of quality, service, and safety.
  • Helps to develop, with Sr. leadership the budget for the department; advise and assist the company with expense budget and cost forecasting.
• Establishes and maintains working relationships with key stakeholders within the organization
• Assists in the development of work plans, task sequencing, and runs test cases to evaluate the extent of how tasks may be performed concurrently.
• Supports short and long term operational/strategic business activities.
• Manages best-practices and tools for performance improvement plan execution and management.
• Ability to coordinate or manage multiple projects across the Health System.
• Perform related duties as requested.

Minimum Qualifications
1. Valid license and current registration to practice as a Pharmacist issued by the New York State Department of Education (NYSED); and
2. Four (4) years of satisfactory full-time experience as a licensed practicing Pharmacist, of which at least two (2) years shall have been in an administrative, managerial or supervisory capacity in a Pharmacy in a hospital, health or medical facility.

Department Preferences

• Minimum 3 years in pharmacy experience
• Minimum 2 years of pharmacy management experience
• Managed Care
• Medical/Pharmacy billing
• Prior Authorization Experience
• HCPCS codes
• Medical/Pharmacy billing
• Prior Authorization Management

If applying online, please include your cover letter in the same file attachment with your uploaded resume.

NYC Health and Hospitals offers a competitive benefits package that includes:

• Comprehensive Health Benefits for employees hired to work 20+ hrs. per week
• Retirement Savings and Pension Plans
• Loan Forgiveness Programs for eligible employees
• Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts
• College tuition discounts and professional development opportunities
• Multiple employee discounts programs