Manager, Medical Pharmacy

Description

The Manager, Medical Pharmacy is a member of the pharmacy leadership team. The incumbent has responsibility and accountability for overseeing the medical pharmacy clinical, financial, and operational strategy for all business segments including IFB, Commercial, Medicaid and Medicare.

Key accountabilities include, but are not limited to, leading medical pharmacy policy development and utilization management for all segments, new medical drug clinical assessment and management strategy;

and oversight for both internal and delegated medical pharmacy management services. This will include navigating cross-functional processes and systems both within and external to the organization.

This position works closely with the Manager, Pharmacy Operations to ensure cohesion between strategic, clinical, and operational strategies within Pharmacy Services to deliver efficient, effective, and high-quality medical pharmacy services to our customers.

Key Accountabilities

Medical Pharmacy Services Oversight

• Provides oversight and support for all aspects of the medical pharmacy benefit, including elements such as drug policies, clinical services, and utilization management.
• Develops and implements strategies to manage medical drug costs and improve member outcomes consistent across all segments and markets
• Prepares and presents medical drug reviews at Medica's formal approval committee
• Reviews and analyzes medical drug utilization data to ensure optimal usage of medications
• Ensures access to cost-effective medical drugs for our customers
• Develops and implements medical pharmacy policies and procedures
• Ensures compliance with regulatory standards across all segments and markets
• Ensures the efficient and effective delivery of medical pharmacy services for customers
• Represents medical pharmacy services and actively participates in both internal and external cross-functional meetings
• Maintains up-to-date knowledge of new drugs, therapeutic trends, and healthcare laws and regulations
• Maintains accurate and current records of all medical pharmacy decisions and changes
• Addresses inquiries and disputes related to medical pharmacy authorization decisions

Pharmacy Leadership

• Oversees day-to-day processes associated with maintaining medical pharmacy services. Facilitates identification and resolution of barriers so that internal and vendor-delegated programs are implemented and functioning in a high quality, timely, and compliant manner
• Provides leadership, development, guidance, recognition and oversight of direct reports
• Serves as a mentor to staff with a set of goals and objectives that are clear and results-oriented
• Hires, develops, trains and retains high quality staff
• Fosters a collaborative, value-driven team culture of high standards and strong productivity
• Develops and maintains positive relationships with Medica leaders, key vendors, and colleagues within the pharmaceutical industry
• Behaves and leads in a manner that is consistent with Medica's mission, vision, and values

Additional Responsibilities

• Completes projects as assigned
• Actively participates in internal and external pharmacy meetings

Qualifications :

• 5+ years of related experience
• Bachelor's degree in Pharmacy or PharmD preferred

3+ years specifically focused on medical pharmacy management

Previous health plan or medical pharmacy experience is required

Prior experience with medical pharmacy policy development and utilization management required

Skills and Abilities

• Organized and can simultaneously execute through multiple projects and priorities
• Proven track record on consistently achieving desired results
• Self-starter, possessing willingness and ambition to work through ambiguity
• Creative thinker
• Excellent analytical and decision-making skills
• Motivated to problem solve
• Ability to present to an executive audience
• Collaborative, team-oriented spirit
• Excellent written and verbal communication skills
• Customer / patient focused

This position is a Remote role and will work remotely 100% of the time. To be eligible for consideration, candidates must have a primary home address located within any state where Medica is registered as an employer - AR, AZ, FL, GA, IA, IL, KS, KY, MD, ME, MI, MN, MO, ND, NE, OK, SD, TN, TX, VA, WI.

The full salary range for this position is $108,400 - $185,900. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and / or licensure, the position's scope and responsibility, internal pay equity and external market salary data.

In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary.

Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Medica's commitment to diversity, equity and inclusion (DEI) includes unifying our workforce through learning and development, recruitment and retention.

We consistently communicate the importance of DEI, celebrate achievements, and seek out community partnerships and diverse suppliers that are representative of everyone in our community.

We are developing sustainable programs and investing time, talent and resources to ensure that we are living our values.

We are an Equal Opportunity / Affirmative Action employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.

Equal Opportunity Employer / Protected Veterans / Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant.

However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)