Pharmacy Manager

Overview

• Lead the strategic management of Medicare Part D pharmacy benefits, ensuring compliance with CMS guidelines and optimizing clinical quality and cost-effectiveness.
• Develop and implement adherence programs to improve medication rates and contribute to Medicare Star Ratings.
• Drive initiatives to optimize supply chain processes, including mail-order pharmacies and auto-refill programs.
• Address barriers to medication adherence, including cost, transportation, and health literacy challenges.
• Oversee Pharmacy Benefit Manager (PBM) contracts, ensuring compliance and performance targets are met.
• Enhance member satisfaction through optimized processes and communication strategies.
• Manage grievances and appeals related to drug plans, ensuring adherence to CMS standards.
• Collaborate with executive leadership to provide expert guidance on pharmacy benefit strategies.

Key Responsibilities & Duties

• Design clinical interventions to improve adherence rates for key medication classes.
• Optimize 90-day supply fills and mail-order pharmacy utilization to enhance medication access.
• Develop strategies to address barriers to medication adherence proactively.
• Serve as the primary liaison for PBM contract management and performance oversight.
• Lead initiatives to improve member satisfaction with the drug plan.
• Ensure timely handling of grievances and appeals, maintaining compliance with CMS standards.
• Mentor and lead teams, fostering a culture of accountability and professional growth.
• Collaborate across functions to achieve strategic objectives and improve outcomes.

Job Requirements

• Associate of Applied Science (AAS) degree required; advanced education preferred.
• Minimum of 3-5 years of leadership experience managing Medicare Part D benefits.
• 5-7 years of experience in Managed Care Pharmacy or PBM settings preferred.
• Proven ability to lead teams and foster professional growth and accountability.
• Strong cross-functional collaboration skills to achieve strategic goals.
• Expertise in CMS guidelines and regulatory compliance for pharmacy benefits.
• Experience in developing and implementing adherence programs and strategies.
• Ability to optimize supply chain processes and improve medication access.