Pharmacy Program Manager

Quartz Health Solutions; Madison (WI); Remote; USD 91,000 - 114,000; Full time

Job summary

Join a respected health insurance company as a Pharmacy Program Manager, where you'll lead innovative pharmacy programs that enhance community health. This role involves overseeing pharmacy benefit management, ensuring compliance with regulations, and making a tangible difference in members' lives. Enjoy the flexibility of a virtual work environment while contributing to impactful healthcare solutions. If you're passionate about driving change and improving health outcomes, this is the opportunity for you.

Benefits

Flexible Work Environment

Comprehensive Health Benefits

Professional Development Opportunities

Diversity and Inclusion Initiatives

Qualifications

• 5+ years of experience in pharmacy management, focusing on health insurance.
• Familiarity with CMS, NCQA, and HEDIS guidelines is essential.

Responsibilities

• Design and oversee pharmacy benefit management strategies.
• Lead relationships with pharmacy benefit managers to meet contractual requirements.

Skills

Pharmacy Management

Health Insurance Knowledge

Project Management

Data Analysis

Regulatory Compliance

Education

Bachelor's or Associate's degree in health sciences

Healthcare Administration

Tools

Pharmacy Benefit Management Systems

Job description

Pharmacy Program Manager

Job Locations

US-WI-Madison

ID

2025-2208

Category

Clinical Services

Type

Regular Full-Time

Overview

Are you a visionary leader passionate about driving innovation in healthcare? Do you thrive on managing complex pharmacy programs that make a tangible difference in the lives of others? If so, we have an incredible opportunity for you! Join a respected health insurance company that is dedicated to enhancing community health and well-being.

Quartz is a trusted leader in the health insurance industry, committed to providing accessible and affordable healthcare solutions to our members. As a Pharmacy Program Manager, you'll play a pivotal role in overseeing the pharmacy benefits manager relationship and performance, which includes key strategies for regulatory and accreditation compliance activities and pharmacy programs. This position will also Identify, interprets, and implements regulatory standards for various local and state services and oversight of quality assurance activities related to Pharmacy benefits.

Benefits:

Drive the development and execution of innovative pharmacy programs that align with organizational goals and regulatory requirements.
• Make a difference every day by contributing to programs that improve health outcomes for our members.
• Full-time virtual, telecommuting, work from home environment available, if preferred
• Starting annual salary range, based upon skills and experience: $91,100-113,900 plus robust total rewards package.

Responsibilities

• Design, implement, and oversee pharmacy benefit management strategies to optimize member outcomes and cost efficiency.
• Leads relationship with PBM to understand contractual requirements and ensure vendor is meeting expectations.
• Monitors reporting and analysis of delegated functions and any escalation of concerns for engagement and intervention
• Performs complex research and analysis related to compliance with federal, state and local pharmacy regulations in order to support Clinical Services operational compliance.
• Interprets and educate Pharmacy team members regarding NCQA and/or URAC standards and compliance expectations, and monitor compliance and report out compliance.
• Facilitates compliance and quality assurance audits periodic assessments to ensure adherence with contractual and regulatory requirements.
• Designs, develops, and maintains pharmacy benefit reporting tools.
• Provides support for pharmacy-related project management and business analysis requests including, but not limited to, data gathering and analysis, flowcharting of current process and procedures.
• Creating project definitions and scopes, develop recommendations, implementing action plans, completing testing, and assisting compliance with quality assurance reviews.

Qualifications

• Bachelor's or Associate's degree in health sciences, business, healthcare administration, health information management, management engineering, health education or nursing.
• 5+ years of experience in pharmacy management, with a focus on health insurance or managed care.
• Two years of experience in health plan pharmacy and/or pharmacy benefits management setting and previous experience working with CMS, NCQA, DHS and/or HEDIS guidelines.
• Familiarity with pharmacy operations, terminology, and procedures.
• Ability to effectively organize and monitor multiple projects and files to ensure timely and accurate completion.
• Ability to develop and professionally present educational programs/workshops.
• LEAN White belt or greater certification is preferred.

Quartz offers an excellent benefit and compensation package, opportunity for professional growth and a professional culture built upon the foundations of Respect, Responsibility, Relationships, & Resourcefulness. To support a safe work environment, all employment offers are contingent upon successful completion of a pre-employment criminal background check.

Quartz values and embraces diversity and is proud to be an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity or expression, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified person with disability.

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