Manager Clinical Pharmacy Quality and Affordability Programs

Hybrid role (3 days/week in office) at our Burlington, Renton, Spokane, Vancouver, Portland, Medford, Salt Lake City, Boise, Lewiston, or Fargo offices. Candidates must reside within commutable distance of that location or be willing to relocate.

About the Role

Join our Cause to create a person-focused and economically sustainable health care system. As a member of the Pharmacy Service leadership team, the Manager of Clinical Pharmacy Quality and Affordability Programs manages a team of clinical pharmacists, organizing and overseeing clinical pharmacy program development, implementation, and maintenance of clinical drug safety, quality, and affordability programs across all lines of business. The scope includes medications covered under the pharmacy benefit, medical benefit, and specialty medications—all in service of creating a person-focused health care experience.

As a people leader, you will support your team and the lives that depend on us, building and mentoring high-performing teams of clinical pharmacists passionate about quality and patient safety. This role is ideal for someone energized by leadership that matters beyond the bottom line, where clinical excellence, health equity, and making health care easier are the measures of success.

Qualifications

• Bachelor's degree in Pharmacy or Pharm.D; Residency certificate or advanced degree in health care administration, economics, public health, pharmacy administration, finance, or equivalent field preferred
• Minimum 3 years of experience in a patient care setting as well as management or professional business experience in a managed health care system, medical group, hospital, or related business in the health care delivery industry or an equivalent combination of education and experience
• Licensed pharmacist in state of practice

Skills and Attributes

• Strong clinical pharmacy background with ability to demonstrate clinical therapy skills and knowledge
• Strong business acumen, knowledge of health care economics and financing, health care and PBM industry dynamics, benefit design, provider contracting strategies, techniques, and operational processes
• Demonstrated success in managing matrixed professional business relationships in a managed care system, medical group, hospital, or related business in the health care delivery industry
• Excellent verbal and written communication skills; strong business analytical skills and abilities; project management and coordination ability; ability to function effectively as a management team member
• Demonstrated ability to review and analyze data from medication claims, recommending programs and policies to encourage appropriate utilization
• Ability to select, train, and lead staff, manage resources, and prioritize workload
• Demonstrated knowledge of:
  • Medicare/CMS regulations and applicability in administering the Medicare Product
  • Pharmaceutical products, including orals, injectables, infusion products, and chemotherapy
  • Health care coding and payment systems (such as ICD-10, CPT, HCPCS, NDC)
  • Compliance-related activities, legislative and regulatory activities; state and federal laws and rules regarding the practice of pharmacy and regulation of health care industry practices, such as DOLI, PPACA, and HIPAA
• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

Responsibilities

• Prioritizes and manages the implementation and maintenance of clinical pharmacy programs, including (but not limited to) Stars, HEDIS, eValu8, and other clinical safety, quality, and affordability programs which encourage the use of the best value medications and discourage the use of unsafe medications or those with limited clinical value
• Leads and collaborates with departmental and cross-organizational teams and committees (including clinical services, customer services, product, sales, marketing, operations, medical management, contracting/rebates, analytics) and with external vendors
• Assures service levels and activities meet client service level agreements, as well as contractual obligations and compliance, such as state, federal, and CMS regulations or specific member contracts with service guarantees
• Provides routine and/or intermittent reporting and analysis as appropriate of clinical program activities that fall under their oversight. Ensures continuous quality assurance inclusive of documented policies, procedures, and workflows for all programs
• Provides leadership and mentorship to direct reports, including clinical and non-clinical staff, through development and tracking of performance goals and objectives, as well as through quarterly performance conversations. Prioritizes and manages work activities of clinical pharmacist consultant staff
• Collaborates with the Pharmacy Directors, VPs, and other leadership in coordinating corporate-wide activities related to the appropriate use of medications, improved quality related to medication therapy, promotion of cost-effective prescribing, and reduction in short-term and long-term overall costs to internal and external clients
• Handles all management-level responsibilities for staff, including hiring, firing, coaching, counseling, and retention. Manages financial targets and department budget, authorizes expenditures, monitors workforce allocation and resources, and oversees project plans
• As a member of our strong leadership community, provides direction to your team, engages them toward common goals, and creates a positive experience that helps people flourish

Up to 10 direct reports.

Pay

Pay ranges vary based on the candidate's work location, skills, experience, education, training, relevant licensure/certifications, and performance history.

• Oregon, Washington, Utah, and Idaho: The expected hiring range is $148,800 - $201,300, the full salary range is $140,000 - $228,000, and the bonus target is 25%.
• North Dakota: The expected hiring range is $146,149.85 - $197,732.15, and the full salary range is $129,767 - $214,115.

About Cambia

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether helping members, lending a hand to a colleague, or volunteering in our communities, our compassion, empathy, and team spirit always shine through.

Benefits

• Medical, dental, and vision coverage for employees and their eligible family members, including mental health benefits
• Annual employer contribution to a health savings account
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period)
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave)
• Award-winning wellness programs that reward you for participation
• Employee Assistance Fund for those in need
• Commute and parking benefits

We are happy to offer work-from-home options for most roles. To take advantage of this flexible option, employees must have a wired internet connection that is not satellite or cellular, with a minimum upload speed of 5Mb and a minimum download speed of 10Mb. As part of our security requirements, new hires will need access to a personal mobile device to set up Multi-Factor Authentication (MFA) upon joining the company.