Manager, Clinical Pharmacy Programs

Community Health Choice; Houston (TX); On-site; USD 140,000 - 180,000; Full time

Benefits offered by this job

Harris Health benefits

Job summary

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.

Qualifications

• 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.

Responsibilities

• 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.

Skills

Analytical

Communication

Problem-solving

Cross-functional collaboration

Education

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

Job description

Houston, Texas | Texas-Based Candidates Only | Houston-Area Candidates Strongly Preferred

Purpose in Practice. Lead Pharmacy Programs That Improve Lives.

At Community Health Choice, we're more than a health plan. We're a local, nonprofit organization dedicated to improving the health and well-being of Texans, especially those in underserved communities.

We're seeking an experienced Manager, Clinical Pharmacy Programs to lead clinical pharmacy initiatives that improve medication access, enhance quality of care, and support responsible pharmacy benefit management.

This is an opportunity for a managed care pharmacy professional who brings clinical expertise and strategic leadership. You'll oversee pharmacy benefit operations, lead medication management programs, analyze utilization trends, and collaborate across the organization to develop solutions that improve outcomes for our members.

Built to Care. Driven to Improve Lives. If you're ready to put your pharmacy expertise and leadership skills to work for a greater purpose, we'd love to hear from you.

Responsibilities include:

Lead Clinical Pharmacy Programs

• Manage clinical and operational pharmacy benefit functions across assigned health plan products.
• Lead complex medication management initiatives and oversee the Medication Therapy Management (MTM) program.
• Develop and enhance drug utilization management strategies, including high-cost medications, formulary management, and cost-effective treatment options.
• Serve as a clinical pharmacy resource to Care Management, Service Coordination, and Utilization Management teams.
• Analyze medical and pharmacy claims, utilization patterns, and prior authorization data to identify trends, outliers, and improvement opportunities.
• Recommend strategies to optimize medication utilization, improve clinical outcomes, and manage pharmacy costs.
• Support Fraud, Waste, and Abuse (FWA) monitoring and reporting initiatives.
• Use data and performance metrics to guide program enhancements and process improvements.

Oversee Pharmacy Benefit Management

• Conduct clinical reviews of prior authorizations, appeals, non-formulary exceptions, and medication override requests.
• Oversee prior authorization criteria and delegated utilization management activities performed by the Pharmacy Benefit Manager (PBM).
• Collaborate with internal teams and external partners to support effective, compliant pharmacy benefit administration.

Lead and Develop Your Team

• Supervise and support clinical pharmacists, pharmacy technicians, and pharmacy students as assigned.
• Provide clinical guidance, coaching, and leadership to support team performance.
• Partner with the Director of Pharmacy Analytics and cross-functional leaders to advance departmental goals and continuous improvement initiatives.

Required Qualifications:

• Bachelor of Science in Pharmacy or Doctor of Pharmacy (PharmD) degree.
• Active Texas pharmacist license, or ability to obtain Texas licensure before the start date.
• At least five years of applicable managed care pharmacy experience as a registered pharmacist; OR at least four years of relevant pharmacy experience combined with advanced training, such as a PGY1 managed care pharmacy residency or an advanced degree in a quantitative discipline.
• At least four years of experience supporting Medicare, Medicaid, and/or Marketplace products within a health plan or Pharmacy Benefit Manager (PBM).
• Strong experience with drug utilization management, including prior authorizations, formulary management, and pharmacy benefit administration.
• Advanced Microsoft Excel skills and proficiency with Word, PowerPoint, and Outlook.
• Strong analytical, communication, problem-solving, and cross-functional collaboration skills.

Preferred Qualifications:

• Doctor of Pharmacy (PharmD) degree.
• Experience with SQL and healthcare data analysis.
• Familiarity with Microsoft Visio.
• Experience leading or supervising clinical pharmacy professionals.

At Community Health Choice, your work contributes to something bigger. As a nonprofit health plan with deep roots in Houston, we're committed to making quality healthcare more accessible and helping our members live healthier lives.

Here, you'll lead meaningful pharmacy initiatives, collaborate with dedicated healthcare professionals, and help shape programs that make a difference for the people and communities we serve.

Purpose in Practice.

Bring your expertise, your leadership, and your commitment to better healthcare to Community Health Choice.

Location: Texas-based candidates only. Candidates located in the Greater Houston area are strongly preferred.

Community employees' benefits are provided by Harris Health. These benefits are designed to provide you with flexibility and options to meet your specific needs.

Community is an Equal Opportunity Employer.

Harris Health's benefits program is designed to provide you with greater flexibility and more choices to meet your specific needs. Harris Health's benefits program allows you to protect your income in case of illness, death, and disability, and to help you save for retirement.