Healthcare is confusing, but it doesn’t need to be. eternalHealth is a a consumer-centric, start-up Medicare Advantage Health Plan based in Boston. We are committed to creating long-lasting partnerships with our members, our providers, and you!
About the role: As the Medicare Director of Pharmacy with eternalHealth, you will report to the Chief Medical Officer (CMO) and be accountable for organizational leadership, performance, and operations for Pharmacy. This role offers the unique opportunity to be an integral part of eternalHealth’s growth and expansion initiatives in Medicare.
As the Director of Pharmacy, you will support the essential duties of eternalHealth to ensure we provide quality products and service for our members.
We provide a unique opportunity to be a part of a health plan in its beginning stages and by taking advantage of this rare opportunity, you will be able to have insight into all the operations and expertise that is required to run a successful and sustainable plan. Our team members are flexible and able to play different roles, while staying committed to teamwork and collaboration, and passionate about sustainable change.
Responsibilities:
Own and manage day-to day pharmacy operations, clinical programs and strategic initiatives.
Ensure Pharmacy meets all applicable regulatory, statutory rules and requirements.
Manage and oversee relationships and contractual commitments with all key vendors (e.g. Pharmacy Benefit Manager) supporting Pharmacy.
Develop and maintain Pharmacy benefit design in conjunction with other eternalHealth stakeholders.
Partner with the CMO and clinical management to ensure best-in-class clinical support and quality initiatives, including Star measures.
Create and maintain policies and procedures and desktop work instructions for Pharmacy.
Participate in Annual Readiness activities.
Support audit activities and Centers for Medicare and Medicaid Services (CMS) facing consultation.
Accountable for Pharmacy key performance indicators (KPIs) to identify performance opportunities and trends.
Communicate our brand, values, and differentiators effectively and accurately.
Maintain strict privacy and confidentiality in accordance with eternalHealth’s security standards.
Working with eternalHealth: eternalHealth is an Equal Opportunity Employer which means that we are committed to upholding discrimination-free hiring practices. As a woman-led company, and one committed to diversity at all levels, we strive for an organization of inclusion and acceptance. We are changing healthcare for the better, starting with our own diverse and passionate teams. As an eternalHealth employee you will be empowered to contribute to our teams and strategy, regardless of previous healthcare experience. Our valued team members are encouraged and expected to offer new solutions and creative input, all while keeping in line with eternalHealth’s mission, values, and compliance standards.
Accommodations: Any eternalHealth applicant will be considered based entirely on their individual qualifications. Should you require reasonable accommodations during the application process (which may include a job-related assessment) please contact us at human.resources@eternalhealth.com.
Requirements:
Bachelor’s degree required in Pharmacy.
Active Pharmacist license.
Minimum of 5 years of Managed Care, Pharmacy Benefit Manager (PBM) experience.
Ability to work in-person from our Boston based office.
Strong understanding of CMS requirements related to Medicare Part D operations and compliance.
You’re a relationship builder and a team player.
Excellent written and verbal communication skills.
Proficiency in Microsoft Word, Excel, and PowerPoint.
Ability to think outside the box and offer creative and compliant solutions to existing and new problems.
Preferred:
Medicare Part D health plan or PBM experience.
Prior experience with CMS program audits and Part D reporting.
Excellent organizational and program management skills.
A Letter From Our CEO
Why transparency and trust in your healthcare
partner is our priority.
Dear Fellow Residents of Massachusetts,
I would like to start by introducing myself. My name is Pooja Ika and like many of you, I was born and raised in Massachusetts. Today, I’m the founder and CEO of eternalHealth , a locally owned Massachusetts healthcare plan with a simple objective: Deliver high quality, affordable care so that we can make care accessible for all Americans. The people of Massachusetts have every right to demand high quality,affordable care from their insurers, and we know that the healthcare industry can and should do better for their members. At eternalHealth , we are committed accomplishing to that mission.
Although eternalHealth was officially founded in 2019, I have been surrounded by the healthcare industry for as long as I can remember. One of my fondest memories growing up as a child was accompanying my mother to her office. She was a primary care physician in Worcester and seeing the relationships and bonds she was able to build with her patients inspired me even at the age of 10. Up until my senior year of high school, I wanted to be a doctor and fo...llow in my mother’s footsteps. However, as I learned more about myself, I realized that my true calling was in health insurance and that this industry is a place where I could harness my own skill set to its fullest potential to initiate real change. Now, I wake up every morning excited at the opportunity to be able to be an advocate for my members and truly transform the health insurance landscape for the better.
At eternalHealth , we tell our members that we want to be their forever partner in healthcare. We are committed to being a new kind of plan that does things the right way and by focusing on establishing real,sustainable relationships with our members, we hope to offer the quality care that they need. Not only will eternalHealth prioritize our members’ care, but we are committing to put their care at the forefront of every decision that we make. At our core, we believe in operating with integrity, honesty, and transparency with all of our partners, whether that be our members, the health systems, doctors, or other vendors. We understand the importance of accepting feedback when building sustainable relationships. With that in mind, we have built and will continue to build upon our product and processes that address our partners needs and pain points.
Out of the $4 trillion spent in healthcare, $900 billion in administrative and operational costs are wasted annually. This not only tells us that there is enough money in the system to take care of our most vulnerable populations, but also that there is enough to care for the uninsured and under insured populations. eternalHealth will work to substantially reduce this waste through the relations we build with our extended family as well as our innovative platform. We hope to then pass down our savings to our members through affordable plans and high-quality benefits.
eternalHealth is a woman-owned, women-run, and women-built company. By investing in education and retention strategies for women, we will be able to foster both professional growth and development,ultimately increasing the representation of women at executive levels in this industry. We want our workforce to represent the people of Massachusetts and beyond, and so we are committed to inclusivity and diversity in all forms.
Millions of Americans do not have the luxury of not worrying about their healthcare, and this is the change I am trying to drive forward. eternalHealth is very proud to be a Massachusetts-based company that isfocused on the specific needs of the people. Having a grandmother who is a Medicare beneficiary in Worcester County has allowed me to explore the best opportunities for care that I can with the ultimate goal of being able to offer a product that I would feel comfortable and proud to enroll my own grandmother in.
So, I welcome and thank you coming on this journey with us. I welcome all feedback and I look forward to working for the people of Massachusetts so that we can collectively deliver and receive better care.
Warmly,
Pooja Ika
CEO & Chairwoman