Manager, Medicare Pharmacy Operations

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're 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 within 120 days of hire.What a day in the life of a Clinical Pharmacist looks 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 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 as 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 we are looking for:Good verbal and written communication skills.Independent and critical thinking.Experience with PBMs and retail claims processing systems.Data analytics and financial analysis skills.Utilization management (step therapy, prior authorization).Effective communication with internal and external customers.Health insurance pharmacy benefit design knowledge.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 considers various factors including competencies, education, qualifications, certifications, experience, skills, seniority, performance, shift, travel, internal equity, geography, organizational needs, and market data. At Blue Cross of Idaho, it is uncommon to be hired at or near the top of the range. Compensation decisions depend on circumstances at the time of offer.We offer a comprehensive benefits package including paid time off, holidays, community service and self-care days, medical/dental/vision/pharmacy insurance, 401(k) matching, life insurance, disability plans, education reimbursement, employee assistance program (EAP), adoption assistance, and paid family leave.We adhere to all relevant laws concerning employee leave benefits.Reasonable accommodations: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.We are an Equal Opportunity Employer and do not discriminate against any employee or applicant based on race, color, sex, age, national origin, religion, sexual orientation, gender identity, veteran status, disability, or any other protected class. #J-18808-Ljbffr