The Pharmacy Manager, Medical Pharmacy is a member of the pharmacy leadership team. The incumbent has responsibility and accountability for overseeing the medical pharmacy clinical, financial, and operational strategy for all business segments including IFB, Commercial, Medicaid and Medicare. Key accountabilities include, but are not limited to, leading medical pharmacy policy development and utilization management for all segments, new medical drug clinical assessment and management strategy; and oversight for both internal and delegated medical pharmacy management services. This will include navigating cross-functional processes and systems both within and external to the organization. Performs other duties as assigned.
Key Accountabilities Medical Pharmacy Services Oversight- Provides oversight and support for all aspects of the medical pharmacy benefit, including elements such as drug policies, clinical services, operational processes and utilization management.
- Develops and implements strategies to manage medical drug costs and improve member outcomes consistent across all segments and markets.
- Prepares and presents medical drug reviews at Medica's formal approval committee.
- Reviews and analyzes medical drug utilization data to ensure optimal usage of medications.
- Ensures access to cost-effective medical drugs for our customers.
- Develops and implements medical pharmacy policies and procedures.
- Ensures compliance with regulatory standards across all segments and markets.
- Ensures the efficient and effective delivery of medical pharmacy services for customers.
- Represents medical pharmacy services and actively participates in both internal and external cross-functional meetings.
- Maintains up-to-date knowledge of new drugs, therapeutic trends, and healthcare laws and regulations.
- Maintains accurate and current records of all medical pharmacy decisions and changes.
- Addresses inquiries and disputes related to medical pharmacy authorization decisions.
- Identifies areas of operational improvements for medical pharmacy management.
Pharmacy Leadership- Oversees day-to-day processes associated with maintaining medical pharmacy services. Facilitates identification and resolution of barriers so that internal and vendor-delegated programs are implemented and functioning in a high quality, timely, and compliant manner.
- Provides leadership, development, guidance, recognition and oversight of direct reports.
- Serves as a mentor to staff with a set of goals and objectives that are clear and results-oriented.
- Coordinate workload, prioritization, and resource allocation to ensure timely delivery of clinical deliverables.
- Support knowledge development, standard work, and process improvement within the medical pharmacy function.
- Hires, develops, trains and retains high quality staff.
- Fosters a collaborative, value-driven team culture of high standards and strong productivity.
- Develops and maintains positive relationships with Medica leaders, key vendors, and colleagues within the pharmaceutical industry.
- Serve as a clinical escalation point for complex or high-risk pharmacy issues.
- Partner with regulatory, compliance, legal, and quality teams to ensure governance processes meet oversight expectations.
- Manage stakeholder relationships with internal and external partners.
- Communicate medical pharmacy strategy clearly to both clinical and non-clinical audiences.
Required Qualifications - Bachelor's degree in Pharmacy or PharmD required
- 5+ years of related work experience in health plan pharmacy, PBM clinical management, or related clinical leadership beyond degree
Required Certifications/Licensure - Active MN pharmacist license, or eligible for MN pharmacist license
Preferred Qualifications - Demonstrated experience with:
- Medical pharmacy drug policies
- Medical pharmacy claims processing
- Delegate management
- Experience working within regulated environments (Medicare and/or Medicaid)
- Board certification (e.g., BCPS or other relevant specialty)
- Experience in plan led or hybrid PBM models
- Familiarity with accreditation and regulatory frameworks (e.g., CMS, NCQA)
- Leadership experience overseeing clinical pharmacists or matrixed teams
- Clinical credibility and sound judgment
- Strong governance mindset and attention to consistency
- Ability to translate evidence into practical, defensible clinical positions
- Executive level presentation and communication skills
- Collaborative, cross functional leadership
This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, Madison, WI, St. Louis, MO, or Omaha, NE.
The full salary grade for this position is $113,400 - $194,400. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $113,400 - $170,100. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.
The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.
Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.
