Manager – Clinical Pharmacy

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Job Description:

  • Insuring evidence-based medication utilization among our membership through prior authorization criteria development and implementation
  • Upholding defined clinical turnaround times and goals set forth in current contracts, accreditation standards and corporate guidance
  • Providing clinical insight and leadership to direct reports
  • Reviewing formulary, utilization management, and drug pipeline guide GEHA decision making
  • Responsible for the day-to-day clinical management of the pharmacy benefit, team, and deliverables
  • Provide clinical guidance, support and oversight to the assigned clinical team
  • Independently completes accurate and comprehensive clinical review of internal and external impacts; provides recommendations as applicable
  • Serves as clinical pharmacy SME on projects and clinical care activities
  • Works across internal teams and partners to align strategic initiatives related to HEDIS and member experience optimization
  • Works in partnership with division leadership to implement and maintain regulatory compliance (AAAHC, OPM, OIG, etc)

Requirements:

  • Doctor of Pharmacy (PharmD) degree from an ACPE-accredited School of Pharmacy
  • Candidate must be licensed, or eligible for licensure, within the state of Missouri
  • Candidate must have 3 years of health plan experience
  • Candidate must have experience leading direct reports or cross-functional teams
  • Candidate must have experience with healthcare claims data (medical and pharmacy)
  • Preferred MBA or demonstrated business background
  • Knowledge of the Medicare Advantage benefits
  • Knowledge of NCQA (HEDIS®) technical specifications
  • Federal Employee Health Benefit (FEHB) experience
  • Proficient in Microsoft Office (Outlook, Word, Excel, Vizio and Microsoft Teams)

Benefits:

  • Competitive pay/salary ranges
  • Incentive plan
  • Health/Vision/Dental benefits effective day one
  • 401(k) retirement plan: company match – dollar for dollar up to 4% employee contribution (pretax or Roth options) plus a 6% annual company contribution
  • Robust employee well-being program
  • Paid Time Off
  • Personal Community Enrichment Time
  • Company-provided Basic Life and AD&D
  • Company-provided Short-Term & Long-Term Disability
  • Tuition Assistance Program
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