Manager, Clinical Pharmacy Quality and Affordability Programs

Jobtailor

Idaho

On-site

USD 120,000 - 180,000

Full time

14 days+

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Job summary

Jobtailor in Idaho seeks a Pharmacy Quality Leader to develop and optimize clinical and affordability programs within a managed care framework. You will lead cross‑functional initiatives, manage external partnerships, and ensure CMS compliance while driving outcomes and cost efficiencies.

The role requires strong clinical pharmacy expertise, strategic thinking, and demonstrated leadership in a matrix environment.

Qualifications

Licensed pharmacist in state of practice.
Minimum 3 years in patient care and managed health care setting or equivalent.
Strong clinical pharmacy background with therapy skills.
Business acumen and knowledge of health care economics.
Experience managing external vendors/consultants and governance.

Responsibilities

Develops, prioritizes, implements, and optimizes quality and clinical programs (e.g., Medicare Stars, HEDIS).
Identifies opportunities to improve program performance and outcomes.
Leads cross-functional initiatives across Pharmacy, Quality, Analytics, Product, and Operations.
Ensures service levels, compliance, and contractual obligations with clients and CMS.
Provides reporting and analysis of clinical program activities.
Mentors staff and manages workload across teams.

Skills

Pharmacy leadership

Clinical pharmacy expertise

Quality program management

Vendor management

Strategic planning

Cross-functional collaboration

Data analysis

Education

Bachelor's degree in Pharmacy

Pharm.D

Residency certificate

Advanced degree (health care administration, public health, or related)

Job description

Develops, prioritizes, implements, and optimizes pharmacy quality, affordability, and medication management programs, including Medicare Stars, HEDIS, and other clinical initiatives.
Identifies opportunities to improve program performance, member outcomes, and operational effectiveness.
Builds partnerships and leads cross-functional initiatives involving Pharmacy, Quality, Analytics, Product, Provider Enablement, Care Management, Operations, Network Management, and external vendors to achieve organizational goals.
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.
Collaborates with the Pharmacy Directors, VPs, and other leadership in coordinating corporate‑wide activities related to the appropriate use of medications, improved quality related to medication therapy, promotion of cost‑effective prescribing, and reduction in short‑term and long‑term overall costs to internal and external clients.
Provides strategic oversight of assigned vendor relationships, including implementation, performance monitoring, governance, operational optimization, and evaluation of new opportunities that support organizational priorities.
Identifies emerging trends, regulatory changes, and innovation opportunities that improve quality outcomes, affordability, member experience, and business performance.
Handles all management level responsibilities for staff, hiring, firing, coaching, counseling, and retention.
Manages financial targets and department budget, authorizes expenditures, monitors workforce allocation and resources, and oversees project plans.

Requirements

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.
Strong clinical pharmacy background with ability to demonstrate clinical therapy skills and knowledge.
Strong business acumen, knowledge of health care economics and financing, health care and PBM industry dynamics, benefit design, provider contracting strategies, techniques, and operational processes.
Demonstrated ability to develop and execute strategic initiatives, identify opportunities for innovation, and translate complex business challenges into actionable solutions.
Experience managing external vendors, consultants, or strategic partners, including performance monitoring, operational governance, implementation oversight, and issue resolution.
Demonstrated success influencing stakeholders and leading cross‑functional initiatives in a matrixed environment.
Ability to build partnerships, align priorities, and drive results across multiple business areas without direct authority.
Excellent verbal and written communication skills; strong business analytical skills and abilities; project management and coordination ability; ability to function effectively as a management team member.
Demonstrated ability to review and analyze data from medication claims, recommending programs and policies to encourage appropriate utilization.
Ability to select, train and lead staff, manage resources and prioritize workload.

Core Competencies

Demonstrates expertise in pharmacy quality management, medication therapy optimization, and compliance with regulatory standards. Proven ability to lead cross‑functional teams, manage vendor relationships, and drive strategic initiatives to enhance patient outcomes and operational efficiency.

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