Full Job Description
Position Summary:
The Pharmacy Program Manager is responsible for the end-to-end oversight of McLaren Health Plan's Pharmacy Benefit Manager (PBM) vendor relationship, contract compliance, and Rx program implementation across all lines of business. This position serves as the operational bridge between McLaren Health Plan and its PBM partner, ensuring contractual obligations are met, pharmacy programs are implemented effectively, and quality initiatives for Medicaid, Medicare, and Commercial lines of business are driven to successful outcomes. The Pharmacy Program Manager will work cross-functionally with clinical, compliance, quality, finance, and regulatory teams to optimize pharmacy benefit performance and member outcomes.
Required:
• Bachelor's degree in pharmacy, healthcare administration, business, or a related field; or an Associate degree in pharmacy, healthcare administration, business, or a related field and two (2) years related experience; or a High School Diploma or equivalent (GED) and four (4) years related experience.
• Three (3) years' experience in pharmacy operations, managed care, or PBM environment.
• Two (2) years' experience with PBM vendor management, contract oversight, or pharmacy program operations.
• Two (2) years' experience working with Medicaid managed care pharmacy requirements and/or Medicare Part D pharmacy benefit administration.
• Two (2) years' experience in project management with experience managing multi-stakeholder implementations.
Preferred:
• Project Management Professional (PMP) certification or equivalent experience.
• A valid, current, unrestricted Michigan license or certification as either a Certified Pharmacy Technician (CPhT) or Registered Pharmacist (RPh)
• Two (2) years' experience with NCQA Health Plan Accreditation and/or URAC standards.
• Two (2) years' experience with CMS Star Ratings, HEDIS pharmacy measures, and Medication Therapy Management programs.
• Two (2) years' experience in Michigan Medicaid (MDHHS) managed care contract requirements and CHAMPS.
• Two (2) years' experience with pharmacy data analytics platforms, reporting tools, or business intelligence systems.
• Two (2) years' managed care experience across multiple lines of business (Medicaid, Medicare, Commercial).
