Manager, Pharmacy Experience and Access

About the role

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the “12 Angry Seniors.” Their mission continues to guide everything we do. Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults. Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity.

Responsibilities

• Lead and support CMS Part D program audits and data validation audits;
• Manage audit universe files, including HPMS reporting requirements;
• Ensure ongoing audit readiness through mock audits, compliance monitoring, and post-submission reviews;
• Lead the Pharmacy Experience & Access team to oversee and optimize PBM delegated programs (DUR, FWA, Patient Safety Analysis, Opioids) for compliance and effectiveness;
• Ensure CDAG operations (e.g., coverage determinations and appeals) are timely and compliant with CMS’s regulations;
• Implement new CMS programs and process enhancements that strengthen compliance, efficiency, and member experience through routine tracking and trending;
• Maintain up-to-date clinical policies and desktop procedures, ensuring internal adherence across clinical operations;
• Serve as subject matter expert for Part D coverage determinations and redeterminations;
• Stay current with Medicare Part D regulations by attending CMS calls and applying released guidance to maintain compliance;
• Oversee PBM operations, collaborating on process improvements and CMS updates to support quality performance and enhance member experience;
• Provide supervision, development, and coaching to pharmacists, technicians, and support staff, fostering a culture of process improvement, operational excellence, and compliance;
• Supervise/Manage Others (i.e. hires, performance reviews, corrective action, etc.).

Requirements

• Graduate or Advanced Degree, Pharm D required.
• Active Pharmacist License required.
• Completion of a PGY1 and/or PGY2 residency or equivalent clinical practice experience preferred.
• Demonstrated knowledge of and experience monitoring Medicare Part D regulations, required.
• 5+ years or more of managed care pharmacy experience; or equivalent experience in a managed care setting, strongly preferred.
• 1-2 Years Leadership/management Experience Strongly Preferred.
• Knowledge and experience with organizing quality improvement initiatives and presenting findings to leadership.

Qualifications

• Strong analytical, problem-solving, and decision-making abilities - Ability to think strategically while executing tactically - Detail-oriented and highly adaptable to a fast-paced, evolving environment - Demonstrated ability to manage multiple priorities simultaneously
• Proven leadership, manager, and accountability skills - Strong organizational, time management, and project management capabilities - Self-starter with a resourceful and innovative mindset - Effective across cross-functional teams and collaborative environments
• Exceptional verbal, written, and interpersonal communication skills - High commitment to professionalism and customer service - Computer proficiency required to perform essential job functions

Benefits

• Annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO)
• 11 paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
• Excellent 401(k) Retirement Saving Plan with employer match and contribution
• Roadmap to Success

Pay

Base salary range: $147,900 to $214,030 per year.

Schedule

Work Mode: Remote