Clinical Pharmacy Quality & Affordability Programs Manager

Cambia Health Solutions; Spokane (WA); Hybrid; USD 135,000 - 195,000; Full time

Benefits offered by this job

Health benefits

401(k) with company match

Generous paid time off

Job summary

Cambia Health Solutions is seeking a Manager of Clinical Pharmacy Quality and Affordability Programs to lead a team of clinical pharmacists and drive program development across pharmacy and medical benefits. The role emphasizes quality, patient safety, and cost-effective prescribing in a large managed care environment.

You will oversee Stars, HEDIS, and other quality initiatives, collaborate with cross-functional leaders, and mentor staff while managing budgets and vendor relationships.

Qualifications

• Bachelor's degree in Pharmacy or Pharm.D; Residency certificate or advanced degree in health care administration, economics, public health, pharmacy administration, finance, or equivalent field preferred
• Minimum 3 years of experience in patient care setting as well as management or professional business experience in a managed health care system, medical group, hospital, or related business in health care delivery industry or an equivalent combination of education and experience
• Licensed pharmacist in state of practice

Responsibilities

• Prioritizes and manages the implementation, and maintenance of clinical pharmacy programs, including (but not limited to) Stars, HEDIS, eValu8, and other clinical safety, quality, and affordability programs which encourages the use of the best value medications, discourage use of unsafe medications or those with limited clinical value.
• Leads, and collaborates with, departmental and cross-organizational teams and committees (including clinical services, customer services, product, sales, marketing, operations, medical management, contracting/rebates, analytics) and with external vendors.
• Assures service levels and activities meet client service level agreements, as well as contractual obligations and compliance, such as state, federal, and CMS regulations or specific member contracts, with service guarantees.
• Provides routine and/or intermittent reporting and analysis as appropriate of clinical program activities that fall under their oversight. Ensure continuous quality assurance inclusive of documented policies, procedures, and workflows for all programs.
• Provides leadership and mentorship to direct reports, including clinical and non-clinical staff, through development and tracking of performance goals and objectives, as well as through quarterly performance conversations. Prioritizes and manages work activities of clinical pharmacist consultant staff.

Skills

Clinical pharmacy

Leadership

Data analysis

Communication

Business acumen

Education

Pharm.D or equivalent

Residency/advanced degree in health care admin/economics/public health/finance

Tools

AI tools experience

Job description

Cambia Health Solutions is seeking a Manager of Clinical Pharmacy Quality and Affordability Programs to lead a team of clinical pharmacists and drive program development across pharmacy and medical benefits. The role emphasizes quality, patient safety, and cost-effective prescribing in a large managed care environment.

You will oversee Stars, HEDIS, and other quality initiatives, collaborate with cross-functional leaders, and mentor staff while managing budgets and vendor relationships.