Sr. Manager, Pharmacy

At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States.  And we've just started. So join us on this mission!

Job Description

A bit about this role: 

The Devoted Health Plan Pharmacy team plays a critical role in ensuring appropriate medication use and optimizing therapeutic outcomes for our members. As the Senior Pharmacy Manager of Utilization Management, you will lead and execute pharmacy benefit strategies that drive appropriate utilization, reduce unnecessary drug spend, and improve health outcomes. You will manage a high-performing team of pharmacists and pharmacy technicians, fostering a collaborative, mission-driven culture centered on clinical excellence and compassion. This role also works closely with providers across Devoted’s national footprint to streamline communication and ensure transparent, timely decisions on coverage. You will collaborate with Network, Clinical, and Compliance teams across multiple states to align utilization management operations with regional provider engagement strategies and regulatory requirements.

Your  Responsibilities and Impact will include :

• Lead a team of clinical pharmacists and pharmacy technicians responsible for utilization management decision-making and member/provider support across Medicare Part B drugs and relevant durable medical equipment.

• Develop and oversee drug policy criteria, leveraging clinical evidence, rebate analytics, and formulary strategy to ensure appropriate, cost-effective access to medications.

• Build and refine communication strategies with providers to ensure clarity, transparency, and efficiency in coverage decisions, including provider education on preferred products and prior authorization requirements.

• Collaborate with regional Network teams to ensure alignment of pharmacy utilization strategies with local provider relationships, clinical goals, and state-specific regulations.

• Partner with analytics, medical, and product teams to design data-driven workflows that surface performance trends and utilization opportunities for timely intervention.

• Support rebate optimization efforts by aligning prior authorization strategies with preferred product access, financial goals, and market shifts.

• Monitor evolving CMS guidance and ensure utilization management practices meet regulatory requirements and audit standards.

• Lead operations for offshore clinical partners who assist us in workflows.

• Weekend on call rotation is mandatory.
   

Required skills and experience:

• PharmD or equivalent advanced degree in pharmacy.

• Minimum of 4-6 years of experience in pharmacy utilization management (Part B Drugs & Biologics), Medicare, or health plan strategy roles.

• Strong working knowledge of Medicare Part B and D regulations, CMS audit protocols, and pharmacy benefit design.

• Proven ability to lead cross-functional initiatives using data to drive operational and strategic improvements.

• Exceptional written and verbal communication skills, with the ability to synthesize clinical, regulatory, and financial insights into actionable decisions.

• Excellent analytical skills with the ability to manage and interpret large datasets, including proficiency in Google Sheets

Desired skills and experience:

• Things move swiftly at a startup - enjoying  a fast paced environment is key. 

• Love the details and organizational skills are a strong-suit.

• Understanding urgency and having the ability to juggle multiple priorities.

• You’re a problem solver by nature - schedules will change, things will come up, the printer will break, people will ask you for help.

• You can see the process and ways to make it better.

• Ability & agility to multitask -  you may be asked to do several things and need to ch