Manager, Pharmacy Operations
$80,300–$116,197 year
RemoteUnited States
United StatesRemoteFull Time$80,300–$116,197 yearLarge
Full TimeLarge
Job Summary
Lead the pharmacy operations team in ensuring regulatory compliance with CMS Part D requirements, including Prescription Drug Event data, Drug Plan Finder processes, and financial reporting. Provide leadership to pharmacy benefit administrators and analysts while overseeing annual BID submissions, audit readiness for CMS and National MEDIC audits, and daily PBM oversight for claims adjudication and automated reprocessing. Manage pharmacy benefit configurations, network access, and data validation activities, fostering continuous process improvement and cross-functional collaboration to drive departmental goals.
Required Qualifications
- Five (5) years or more of Medicare Part D experience with a health plan or PBM
- Three (3) years of leadership experience in a managed care setting with full scope of supervision for non-licensed staff
- Three (3) years or more of experience in data analysis
- Bachelor's Degree or equivalent experience - Business/Healthcare
- Expert in Medicare Part D
- Knowledge of CMS Part D regulations e.g., CMS Call Letters, MAPD application, Claims Processing, Part D Reports
- Ability to create, develop and implement process improvement and the ability to instill that focus in a team
- Ability to work cross-functionally and collaboratively across the organization
- Technologically savvy and able to utilize information systems effectively (MS Office - Word, Excel, PowerPoint, Access, Visio, Outlook; SQL)
- Ability to manage and adapt to a significant change
- Strong interpersonal skills, including excellent written and verbal communication skills
- Strong organizational skills; ability to multitask and meet multiple competing deadlines
- Ability to appropriately maintain confidentiality
- Strong analytical and critical thinking skills
- Ability to research, analyze, and problem solve
- Self-starter that can take the lead on a project and manage its progress for completion
- Active Pharmacy Technician License preferred
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