Manager Pharmacy Programs

Company :

Job Description : 

JOB SUMMARY

This role leads a team responsible for the development and implementation of innovative prescription drug benefit strategies and programs specifically for the Medicare Advantage (MA) market. The incumbent will manage a team of clinical and non-clinical professionals, driving the design and launch of pharmacy solutions that are compliant, clinically effective, and financially sound. This position demands a highly collaborative leadership style, characterized by strong communication, negotiation, and consensus-building skills.  A proven ability to navigate complex regulatory landscapes (including CMS compliance) and a comfort level tackling ambiguous, high-stakes challenges is crucial for success.

Responsibilities will include:

• Strategic Leadership: Developing and executing the organization's MA pharmacy strategy, including formulary management, benefit design, and program development. This requires a deep understanding of the MA market, competitive landscape, and regulatory requirements, including the implications of the Inflation Reduction Act.
• Team Management & Mentorship: Leading and mentoring a team of professionals in a matrixed environment, fostering collaboration and driving performance toward ambitious goals. Proven experience managing and developing direct reports is essential.
• Cross-functional Collaboration: Working closely with sales, segment support, finance, clinical operations, and other key stakeholders to ensure seamless product development, launch, and ongoing performance. This requires strong communication, negotiation, and influencing skills.
• Financial Acumen: Developing and managing budgets, identifying revenue opportunities, and contributing to the overall financial success of the MA business segment. Demonstrated ability to analyze financial data and make informed decisions is essential.
• Problem-Solving & Decision-Making: Addressing complex challenges requiring innovative solutions, decisive action, and a strategic approach to mitigate risk and maximize opportunities.

While this role focuses predominantly on Medicare Advantage, collaboration with other business segments (ACA and Commercial) may occur on a limited, strategic basis. The ideal candidate possesses exceptional problem-solving skills, thrives in a fast-paced environment, and consistently demonstrates professional maturity and judgment.

ESSENTIAL RESPONSIBILITIES

• Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.  Plans, organizes, staffs, directs and controls the day-to-day operations of the department; develops and implements policies and programs as necessary; may have budgetary responsibility and authority.
• Manages the day-to-day operations facilitating the development and implementation of the Organization’s prescription drug benefit strategies and products tailored to support their applicable core business segment(s), including the Commercial (self-funded and risk)/Healthcare Reform (ACA) business segments, or the Medicare Advantage business segment.  
• Manage deployment of pharmacy product solutions from pilot to full-scale rollout while ensuring all capabilities deliver administrative effectiveness, support market competitiveness/differentiation, customer satisfaction and financial performance.  
• Ensures pharmacy programs and products are monitored and maintained in accordance with contracts, polices, state and federal regulations, as applicable.
• Collaborate with key internal and external stakeholders, including other market segment support and product teams and pharmacy vendors (including PBM)
• Other duties as assigned or requested.

EDUCATION

Required

• Bachelor's degree in Business, healthcare or related field, or relevant experience and/or education as determined by the company in lieu of bachelor's degree

Preferred

• Master's degree in Business, healthcare (i.e. PharmD) or related field

EXPERIENCE

Required

• None

Preferred

• None

LICENSES or CERTIFICATIONS

Required

• 5 years in a Health Plan or Pharmacy Benefit Manager (PBM)

• 3 years of leading healthcare program or product development

Preferred

• None