Manager, Medicare Pharmacy Operations - R3095 - 6334

Clinical Pharmacist Position

Responsible for pharmacy benefit services operations and clinical management for the Medicare line of business (Part D and Part B). This role is also accountable for managing processes related to PBM Performance, Part D adjudication of benefits, and pharmacy audits. Function as a subject matter expert on Medicare Prescription Drug Coverage.

We are looking for a Clinical Pharmacist with:

• 7 years\' health industry or related field experience, with marketing, finance, product strategy and/or managed care responsibility to include leadership
• Education: Doctor of Pharmacy (Pharm D) from an accredited School of Pharmacy; OR Registered Pharmacist (RPh)
• Certifications/Licenses: Idaho Pharmacist License or must obtain with 120 days of hire

What a day of a Clinical Pharmacist would look like:

• Medicare Part D subject matter expert responsible for conveying applicable CMS regulatory guidance and expectations to staff within the pharmacy department.
• Consult with compliance divisions to provide strategic enterprise support.
• Maintain cross-functional relationships with Sales, Account Management, Government Programs, IS/IT, Internal Audit, and other applicable divisions to ensure compliant and accurate administration of pharmacy benefits across delivery systems.
• Manage Part D benefit implementation and provide oversight with the contracted PBM. Ensure pharmacy projects are completed while maintaining a strong focus on Medicare Part D compliance.
• Represent Pharmacy Health Plan in the role of a Medicare Subject Matter Expert by providing current operational state and conveying future needs.
• Update departmental policies as needed.
• Facilitate cross-functional efforts throughout the enterprise to ensure optimal 5-star Medicare measures.
• Support annual readiness, maintain industry knowledge, and provide in-depth analysis to guarantee proper support for Medicare Programs.
• Manage pharmacy audits as they are received.
• Work with leadership to manage the PBM relationship. Ensure Medicare Part D related contract terms are met.
• Address escalations with PBM staff to ensure favorable resolution.
• Work closely with business partners to facilitate prime client/vendor rapport while identifying cost saving opportunities for the enterprise.

Additional skills that we are looking for:

• Good verbal and written communication skills
• Independent and critical thinking
• PBMs and retail claims processing systems
• Data Analytics and financial analysis
• Utilization management (step therapy, prior authorization)
• Communicate effectively with both internal and external customers
• Health Insurance pharmacy benefit design

As of the date of this posting, a good faith estimate of the current pay range is $142,799 to $214,198. The position is eligible for an annual incentive bonus (variable depending on company and employee performance. The pay range for this position takes into account a wide range of factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, internal equity, geography, business or organizational needs, and alignment with market data. At Blue Cross of Idaho, it is not typical for an individual to be hired at or near the top range for the position. Compensation decisions are dependent on factors and circumstances at the time of offer. We offer a robust package of benefits including paid time off, paid holidays, community service and self-care days, medical/dental/vision/pharmacy insurance, 401(k) matching and non-contributory plan, life insurance, short and long term disability, education rembursement, employee assistance plan (EAP), adoption assistance program and paid family leave program. We will adhere to all relevant state and local laws concerning employee leave benefits, in line with our plans and policies.

Reasonable accommodations

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.