Pharmacy Program Manager - Medicaid - SHCN
The Pharmacy Program Manager manages and conducts clinical and operational pharmacy processes for Steward Health Choice Medicaid plan members. The Pharmacy Program Manager maintains the plan Medicaid formularies, participates in the P&T Committee, reviews drug use criteria and protocols, and reviews requests for prescription drug services (prior authorizations). The Pharmacy Program Manager reviews complex member cases, participates in efforts to improve performance measures, works closely with the designated PBM to ensure pharmacy benefit is compliant with government regulations and requirements, and works with state officials and State Medicaid plan pharmacists.
Manage clinical pharmacy processes effectively and efficiently and serve as a subject matter expert for the State Medicaid pharmacy benefit to internal and external customers (Health Choice staff, State Medicaid officials, pharmacy directors, etc.). Conduct activities associated with clinical programs that promote clinically appropriate and safe medication use within Medicaid member and provider populations. Conduct pharmacy and medical drug prior authorization processes accurately, effectively, and efficiently.
Health Choice exists to improve the health and well-being of the individuals we serve through our health plans, integrated delivery systems and managed care solutions. We strive to recruit and retain only the finest health care professionals with the highest levels of integrity, compassion and competency. If you are driven by your own personal commitment to these values and desire to work in a team-focused, collaborative and supportive environment - while still being valued for your individual strengths - Health Choice is the place for you.
Equal Opportunity Employer Minorities/Women/Veterans/Disabled
Pharmacy degree from an accredited College of Pharmacy required; PharmD preferred
Pharmacy licensure in the state of Arizona or Utah, in good standing, required
Current state driver's license, reliable transportation, and current insurance coverage required
At least five (5) years of practice experience with a health plan pharmacy service, managed care environment, and / or retail pharmacy experience
At least two (2) years of practice experience in developing and applying clinical use drug criteria
Proficient in the principles and practices of managed care pharmacy
Broad based knowledge in a variety of pharmacy disciplines
Knowledge of Medicare and Medicaid regulations and guidelines regarding coverage determinations
Knowledge of peer-reviewed literature for production of PA Criteria Guidelines
Knowledge of drug options for the appropriate clinical management of member medical conditions