Manager, Pharmacy Operations - Michigan

McLaren Health Care; Flint (MI); On-site; USD 120,000 - 170,000; Full time

Job summary

McLaren Health Plan seeks a Manager of Pharmacy Operations to lead strategic oversight and day-to-day management of the pharmacy program across Medicaid, Medicare Advantage, and Commercial lines. The role partners with medical management, quality, compliance, finance, and a PBM to drive high-quality, cost-effective, and compliant pharmacy services.

The ideal candidate will have a PharmD or equivalent and several years in managed care pharmacy, including formulary management and supervisory

Qualifications

• Bachelor’s degree in pharmacy, healthcare administration, business, or a related field; or an Associate degree in pharmacy, healthcare administration, business or a related field and two (2) years’ related experience.
• Must possess a valid, current, unrestricted Michigan Registered Pharmacist (RPh).
• Five (5) years of progressively more responsible pharmacy experience, with experience and knowledge of HMO, PPO, TPA, PHO, and Managed care functions with at least two (2) years' experience with formulary management, drug utilization review, and clinical program development, including at least two (2) years in a supervisory role leading or assisting in all phases of effective supervision (i.e. Recruitment, performance management, training).

Responsibilities

• Provide strategic oversight and day-to-day management of McLaren Health Plan's pharmacy program across all lines of business (LOB).
• Collaborate with medical management, quality, compliance, finance, and external PBM partners to drive pharmacy program excellence.
• Lead formulary management, drug utilization review, and clinical program development; provide leadership in supervision and training.

Education

Bachelor’s degree in pharmacy

Associate degree in pharmacy

Tools

Pharmacy claims data

Reporting tools

Population health analytics platforms

Job description

McLaren Health Plan (MHP) is a company with a culture of high performance and a mission to help people live healthier and more satisfying lives. We are looking for a Manager, Pharmacy Operations, to join in leading the organization forward.

MHP is a Managed Care Organization dedicated to meeting the health care needs of each member. MHP offers multiple product lines, including individual and family plans, and Medicaid and Medicare plans to Michigan residents for every stage of life. McLaren Health Plan is accredited by the National Committee for Quality Assurance (NCQA).

MHP values the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plan can thrive. As an employee of MHP, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.

Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org

Position Summary

The Manager of Pharmacy Operations is a licensed clinical leadership position responsible for the strategic oversight and day-to-day management of McLaren Health Plan's pharmacy program across all lines of business (LOB), including Medicaid, Medicare Advantage, and Commercial products. This role serves as a clinical subject matter expert and operational leader, ensuring the delivery of high-quality, cost-effective, and compliant pharmacy services. Reporting to the Director, the Manager position will collaborate closely with medical management, quality, compliance, finance, and external Pharmacy Benefit Manager (PBM) partner to drive pharmacy program excellence.

Qualifications

Required:

• Bachelor’s degree in pharmacy, healthcare administration, business, or a related field; or an Associate degree in pharmacy, healthcare administration, business or a related field and two (2) years’ related experience.
• Must possess a valid, current, unrestricted Michigan Registered Pharmacist (RPh).
• Five (5) years of progressively more responsible pharmacy experience, with experience and knowledge of HMO, PPO, TPA, PHO, and Managed care functions with at least two (2) years' experience with formulary management, drug utilization review, and clinical program development, including at least two (2) years in a supervisory role leading or assisting in all phases of effective supervision (i.e. Recruitment, performance management, training).

Preferred:

• Two (2) years’ Experience with NCQA Health Plan Accreditation and/or Utilization Review Accreditation Commission (URAC) standards.
• PGY-1 or PGY-2 Managed Care Pharmacy Residency experience.
• Familiarity with Michigan Medicaid MDHHS contract compliance requirements and CHAMPS system.
• Proficiency with pharmacy claims data, reporting tools, and population health analytics platforms.
• Familiarity with McLaren Health Plan, McLaren Health Care, or McLaren Integrated HMO Group products.

Additional Information

• Schedule: Full-time
• Requisition ID: 26004101
• Daily Work Times: 8:30AM - 5:00PM
• Hours Per Pay Period: 80
• On Call: No
• Weekends: No