Manager, Clinical Pharmacy

About the role

The Manager of Clinical Pharmacy role oversees and maintains clinical aspects of Commercial, Medicare, and Medicaid pharmacy-related programs. This position focuses on initiating, supporting, and continuing evidence-based, cost-effective medication utilization strategies and clinical programs, while providing clinical support to internal departments and external customers. This role is supported by two Clinical Pharmacy Supervisors, each responsible for distinct workstreams.

Responsibilities

• Oversight of core clinical pharmacy functions, including, but not limited to formulary management (including Pharmacy & Therapeutics Committee), utilization management, prior authorization, and other clinical pharmacy programs.
• Provide oversight and ensure compliance with pharmacy law, state and federal regulations, pharmacy business practices, accreditation practices, and other internal organization policies.
• Manage accessibility, quality, and cost-effectiveness of medication therapy for members and providers.
• Represent clinical pharmacy in audits, appeals-related hearings, and other formal regulatory review processes.
• Develop and maintain pharmacy program policies and procedures to ensure compliance with internal and external requirements.
• Participate as a clinical leader across the operational units to deliver the highest levels of program performance and integrated clinical service to internal and external clients.
• Serve as the clinical leader and point of contact and collaborate with internal and external partners, clients, and vendors to execute pharmacy management strategies and programs.
• Oversee the assignment and completion of key clinical pharmacy activities, such as new drug evaluations, medical necessity criteria creation and maintenance, and formulary enhancements.
• Provide concise, applicable, comprehensive, and timely responses to requests for drug information from members, clients, providers, and internal teams.
• Manage escalated issues arising from a multitude of sources, such as members, providers, vendors, clients, and internal teams or departments, such as customer service or appeals and grievances.
• In collaboration with other department leaders, oversee the quality of the clinical projects, tasks, and deliverables through productivity reporting and quality assurance processes.
• Review, analyze, evaluate, and interpret scientific and medical journals, financial reports, and legal documents to provide recommendations or guidance to other stakeholders.
• Lead and complete significant projects as assigned to meet team and/or business objectives.
• Provide leadership, coaching, performance management, and professional development for clinical pharmacy staff and supervisors.
• Provide oversight and leadership to quality and population health clinical programs.
• Support Director, Clinical Pharmacy and other department leaders on special projects and initiatives that support the current and future needs of the organization and teams.

Requirements

• Doctor of Pharmacy degree (Pharm.D.) preferred, or Bachelors of Pharmacy degree.
• Valid Registered Pharmacist (RPh) license in the State of Oregon, or ability to become licensed within 60 days of employment.
• Success managing a team of pharmacists preferred, or two or more years of supervisory/management experience.
• Three or more years of managed care experience related to Commercial, Medicare, and/or Medicaid benefit administration. Deep Medicare Part D expertise preferred.
• Demonstrated ability to lead multiple complex, concurrent projects and initiatives.
• Demonstrated ability to work with large data sets and experience in identifying and implementing process improvements.
• Ability to work collaboratively with other departments across the Moda organization.
• Advanced understanding of managed care pharmacy landscape and the medication use system.
• Commitment to service, organization values, and professionalism through appropriate conduct and demeanor.
• Ability to maintain confidentiality and project a professional business image.
• Regular attendance, dependability, and promptness required. Ability to attend regular meetings in-person and as needed.
• Proficient with Microsoft Office applications.
• Post-graduate training (residency and/or fellowship) preferred, although not required.

Qualifications

• Doctor of Pharmacy degree (Pharm.D.) preferred, or Bachelors of Pharmacy degree.
• Valid Registered Pharmacist (RPh) license in the State of Oregon, or ability to become licensed within 60 days of employment.
• Three or more years of managed care experience related to Commercial, Medicare, and/or Medicaid benefit administration. Deep Medicare Part D expertise preferred.
• Demonstrated ability to lead multiple complex, concurrent projects and initiatives.
• Demonstrated ability to work with large data sets and experience in identifying and implementing process improvements.
• Ability to work collaboratively with other departments across the Moda organization.
• Advanced understanding of managed care pharmacy landscape and the medication use system.
• Commitment to service, organization values, and professionalism through appropriate conduct and demeanor.
• Proficient with Microsoft Office applications.

Skills

• Leadership skills.
• Collaborative working style.
• Strong communication and interpersonal skills.
• Ability to manage multiple priorities and projects simultaneously.
• Experience with managed care pharmacy operations.
• Knowledge of pharmacy laws, regulations, and best practices.
• Ability to analyze and interpret complex data.
• Strong problem-solving and decision-making abilities.
• Excellent organizational and time management skills.

Benefits

• Medical, Dental, Vision, Pharmacy, Life, & Disability
• 401K- Matching
• FSA
• Employee Assistance Program
• PTO and Company Paid Holidays

Pay

$150,000.00- $200,000.00 annually (depending on experience)

Schedule

Hybrid work arrangement, with occasional evenings and weekends as needed.