Time Type: Full time
Department: Clinical Pharmacy
All Locations: 10 Gove Street - Taylor Building
Position Summary: The Manager, Medication Access & Specialty Pharmacy Operations is responsible for the day-to-day leadership and oversight of medication access and specialty pharmacy services at NeighborHealth. This role ensures patients receive timely, affordable, and clinically appropriate medications by leading operational workflows, supporting specialty pharmacy compliance, and overseeing a high-performing medication access team. Working closely with providers, clinical teams, payers, and operational partners, the Manager drives efficient access to therapy, removes barriers to care, and supports exceptional patient outcomes. This position plays a key role in optimizing medication access services, improving operational performance, and advancing NeighborHealth's commitment to equitable, patient-centered care.
Lead the daily operations of medication access and specialty pharmacy services to ensure patients receive timely, affordable, and clinically appropriate medications. 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 across the organization.
The successful candidate will be able to perform the following responsibilities:
Specialty Pharmacy Operations & Compliance- Manage daily specialty pharmacy operations to ensure compliance with organizational policies, regulatory requirements, and accreditation standards, including ACHC and URAC.
- 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.
- Oversee daily medication access operations, including workload distribution, workflow management, and prioritization of patient access needs.
- 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.
- Partner with pharmacy leadership to support staffing, onboarding, training, performance management, and professional development initiatives.
Formulary Management & Access Support- Monitor payer formulary updates, coverage policies, and utilization management requirements across commercial, Medicaid, and Medicare plans.
- Develop and maintain processes that support medication access, coverage pathway navigation, and therapeutic alternative identification when clinically appropriate.
- 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.
- Facilitate communication of formulary and coverage updates to relevant stakeholders to promote timely and informed clinical decision-making.
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.
- Support escalation-level payer interactions, including coordination of appeals, peer-to-peer reviews, and resolution of complex coverage issues.
- Collaborate with informatics, technology, and operational teams to optimize electronic health record workflows, reporting tools, and medication access processes.
- Foster strong cross-functional partnerships that improve communication, care coordination, operational efficiency, and patient outcomes.
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.
- Collaborate with pharmacy leadership and operational stakeholders to implement process improvements and achieve departmental goals.
- Support initiatives that promote equitable access to medications and reduce barriers to care across diverse patient populations.
Education- 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.
Experience- 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/Abilities- 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.
