Head of Clinical Pharmacy Programs - Managed Care Leader

Community Health Choice; Houston (TX); Vor Ort; USD 140.000 - 180.000; Vollzeit

Benefits dieser Stelle

Harris Health benefits

Zusammenfassung

Community Health Choice in Houston, TX seeks a Manager, Clinical Pharmacy Programs to lead clinical pharmacy initiatives that improve access, quality of care, and cost-effectiveness within a managed care setting.

You'll oversee pharmacy benefit operations, lead MTM and drug utilization management, analyze utilization trends, and collaborate with Care Management, Utilization Management, and other teams to develop solutions that improve member outcomes.

Qualifikationen

• Bachelor of Science in Pharmacy or PharmD required.
• Active Texas pharmacist license or ability to obtain before start date.
• At least five years of managed care pharmacy experience as a registered pharmacist or four years with PGY1 residency or quantitative degree.
• At least four years of Medicare/Medicaid/Marketplace experience in a health plan or PBM.
• Strong experience with drug utilization management including prior authorizations and formulary management.
• Advanced Microsoft Excel; proficient with Word, PowerPoint, Outlook.
• Strong analytical, communication, problem-solving, and cross-functional collaboration skills.

Aufgaben

• Lead clinical and operational pharmacy benefit functions across assigned health plan products.
• Lead MTM program and complex medication management initiatives.
• Develop and enhance drug utilization management strategies and cost-effective options.
• Serve as clinical resource to Care Management, Service Coordination, and Utilization Management teams.
• Analyze claims, utilization patterns, and prior authorization data to identify trends and opportunities.
• Recommend strategies to optimize medication utilization and clinical outcomes.
• Support Fraud, Waste, and Abuse monitoring and reporting.
• Use data and performance metrics to guide program improvements.

Kenntnisse

Analytical

Communication

Problem-solving

Cross-functional collaboration

Ausbildung

Bachelor of Science in Pharmacy or Doctor of Pharmacy (PharmD)

PGY1 residency or advanced degree in quantitative discipline

Tools

Microsoft Excel

Word

PowerPoint

Outlook

SQL

Microsoft Visio

Jobbeschreibung

Community Health Choice in Houston, TX seeks a Manager, Clinical Pharmacy Programs to lead clinical pharmacy initiatives that improve access, quality of care, and cost-effectiveness within a managed care setting.

You'll oversee pharmacy benefit operations, lead MTM and drug utilization management, analyze utilization trends, and collaborate with Care Management, Utilization Management, and other teams to develop solutions that improve member outcomes.