Manager, Medication Access & Specialty Pharmacy Operations

About the role

NeighborHealth is one of the largest community health centers in the country, serving the greater Boston area with a strong commitment to the health and well-being of our patients and communities. The Manager, Medication Access & Specialty Pharmacy Operations leads the day-to-day leadership and oversight of medication access and specialty pharmacy services, ensuring patients receive timely, affordable, and clinically appropriate medications by managing operational workflows, supporting compliance, and overseeing a high-performing medication access team.

Responsibilities

• Lead daily operations of medication access and specialty pharmacy services to ensure timely, affordable, and clinically appropriate medication access.
• Oversee prior authorization, benefit investigation, financial assistance, and specialty medication workflows while maintaining compliance with accreditation and regulatory standards.
• Supervise and develop medication access staff, establish operational performance expectations, and drive continuous process improvement.
• Partner with providers, clinical teams, payers, and operational stakeholders to remove barriers to care, improve access to therapy, and support exceptional patient outcomes.
• Monitor operational performance metrics and implement solutions that enhance efficiency, quality, and equitable access to medications.

Specialty Pharmacy Operations & Compliance

• Maintain and continuously improve policies, procedures, and standard operating workflows supporting medication access and specialty pharmacy services.
• Lead operational readiness activities for specialty pharmacy accreditation programs, including ACHC and URAC documentation review, audit preparation, survey readiness, and corrective action implementation.
• Monitor quality, compliance, and service metrics to identify opportunities for operational improvement, risk mitigation, and ongoing accreditation compliance.
• Collaborate with pharmacy leadership to support ACHC and URAC accreditation activities and ensure adherence to established quality and performance standards.

Medication Access Operations & Team Leadership

• Supervise, coach, and develop medication access pharmacy technicians and liaisons, fostering a culture of accountability, collaboration, and service excellence.
• Ensure timely completion of prior authorizations, benefit investigations, coverage determinations, financial assistance enrollment, and other medication access activities.
• Establish, monitor, and optimize operational performance metrics, productivity standards, and turnaround time expectations.
• Serve as the primary escalation point for complex medication access issues, including denials, appeals, peer-to-peer reviews, medical exceptions, and payer-related challenges.
• Identify workflow barriers and implement process improvements to reduce delays in therapy initiation and enhance the patient and provider experience.

Formulary Management & Access Support

• Monitor payer formulary updates, coverage policies, and utilization management requirements across commercial, Medicaid, and Medicare plans.
• Provide guidance and support to providers and care teams regarding formulary requirements, prior authorization criteria, and medication access pathways.
• Collaborate with pharmacists, providers, and clinical staff to minimize disruptions in patient therapy resulting from formulary or coverage changes.
• Support resolution of patient-specific medication access challenges through established workflows, escalation pathways, and payer engagement strategies.

Provider & Interdisciplinary Collaboration

• Partner with providers, pharmacists, nurses, care teams, and operational stakeholders to support timely and effective medication access for patients.
• Serve as a subject matter expert on medication access processes, payer requirements, and specialty pharmacy workflows.
• Provide consultation and guidance to providers and clinical teams regarding prior authorization requirements, coverage pathways, appeals processes, and access-related barriers.
• Collaborate with informatics, technology, and operational teams to optimize electronic health record workflows, reporting tools, and medication access processes.

Performance Improvement, Analytics & Reporting

• Monitor, analyze, and report on key operational and quality metrics, including prior authorization turnaround times, approval and denial rates, appeal outcomes, and time to therapy initiation.
• Develop and maintain dashboards, reports, and performance tracking tools to support operational oversight and decision-making.
• Identify trends, workflow gaps, and opportunities for improvement through data analysis and routine performance reviews.
• Lead operational improvement initiatives designed to enhance efficiency, service quality, patient access, and team performance.

Requirements

• Doctor of Pharmacy (PharmD) degree from an accredited college or school of pharmacy required.
• Current pharmacist licensure in Massachusetts, or eligibility to obtain Massachusetts pharmacist licensure, required.
• Minimum of five (5) years of experience in specialty pharmacy, medication access services, ambulatory care pharmacy, managed care pharmacy, health-system pharmacy, or a related pharmacy practice setting required.
• Minimum of two (2) years of leadership, supervisory, project leadership, or operational management experience required.
• Experience managing medication access programs, prior authorization processes, pharmacy benefit navigation, or specialty pharmacy services required.
• Experience with ACHC and/or URAC accreditation standards, specialty pharmacy compliance activities, or accreditation readiness strongly preferred.
• Experience with workflow optimization, quality improvement, operational reporting, and performance metric management preferred.

Skills

• Strong knowledge of medication access services, specialty pharmacy operations, prior authorization processes, pharmacy and medical benefit navigation, and payer requirements.
• Demonstrated ability to lead, coach, develop, and motivate teams while fostering a culture of accountability, collaboration, and continuous improvement.
• Strong operational management skills with the ability to prioritize competing demands, manage complex workflows, and drive results in a fast-paced healthcare environment.
• Excellent verbal, written, and interpersonal communication skills, with the ability to effectively engage providers, staff, patients, payers, and external partners.
• Ability to analyze operational and performance data, identify trends, and implement data-driven process improvements.
• Experience with electronic health records, pharmacy systems, reporting tools, and other technology platforms supporting medication access and specialty pharmacy services.
• Strong problem-solving, critical thinking, and decision-making skills with the ability to manage complex patient access challenges and escalated issues.
• Knowledge of ACHC and URAC accreditation standards, specialty pharmacy quality requirements, and regulatory expectations preferred.
• Commitment to patient-centered care, health equity, cultural humility, and serving diverse patient populations.
• Bilingual skills, particularly Spanish, are preferred but not required.