Medicaid Pharmacy Policy Director

Nunez Community College; Baton Rouge (LA); On-site; USD 85,000 - 105,000; Full time

Job summary

The Louisiana Department of Health seeks a pharmacist to oversee Medicaid pharmacy services, ensuring compliance and policy implementation across contractors and providers. You will provide clinical guidance on drug coverage, participate in DUR activities, and help drive cost-containment strategies statewide.

Location is East Baton Rouge Parish; appointment may be probationary or promotional. Requires a current LA pharmacy license and at least two years of experience.

Qualifications

• Must hold a current Louisiana license to practice pharmacy.
• Two years of experience as a licensed pharmacist.

Responsibilities

• Provides regulatory oversight of pharmacy contractors, monitors contractor performance, and ensures compliance with program priorities, standards, and agency policies.
• Provides clinical and technical expertise on Medicaid pharmacy policy, including policy changes, Single Preferred Drug List (PDL) maintenance, and implementation of new or revised requirements.
• Oversees Fee-for-Service (FFS) pharmacy claims operations, including claims submission, clinical overrides, claim interventions, drug file updates, and payment and authorization statuses.
• Develops and approves clinical criteria for drug coverage, participates in Drug Utilization Review (DUR) activities, and recommends strategies to improve prescribing and dispensing practices.
• Coordinates pharmacy benefit activities involving third-party payers, including Medicare Part B and Part D drug coverage, and assists with pharmacy provider enrollment and related payment processing.
• Provides clinical consultation and technical assistance to pharmacy staff, providers, recipients, manufacturers, legislators, and oversight agencies regarding complex pharmacy program and policy matters.
• Participates in Pharmaceutical and Therapeutics Committee activities, reviews clinical and financial drug information, monitors PDL implementation, develops innovative pharmacy practices, and supports disaster preparedness and other program initiatives.

Skills

Pharmacy license

Experience

Job description

The Louisiana Department of Health seeks a pharmacist to oversee Medicaid pharmacy services, ensuring compliance and policy implementation across contractors and providers. You will provide clinical guidance on drug coverage, participate in DUR activities, and help drive cost-containment strategies statewide.

Location is East Baton Rouge Parish; appointment may be probationary or promotional. Requires a current LA pharmacy license and at least two years of experience.