Pharmacy Program Manager

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

Job summary

Join a forward-thinking health insurance company as a Pharmacy Program Manager, where you'll lead the charge in developing innovative pharmacy programs that enhance community health. This role offers the chance to make a significant impact by managing pharmacy benefits and ensuring compliance with regulatory standards. Enjoy the flexibility of a virtual work environment while contributing to projects that improve health outcomes. With a robust salary range and a commitment to professional growth, this opportunity is perfect for those passionate about healthcare innovation and community well-being.

Benefits

Robust total rewards package

Professional growth opportunities

Flexible work from home environment

Qualifications

• 5+ years of experience in pharmacy management in health insurance.
• Familiarity with pharmacy operations and compliance standards.

Responsibilities

• Design and oversee pharmacy benefit management strategies.
• Lead relationships with pharmacy benefits managers and ensure compliance.
• Perform research related to pharmacy regulations and quality assurance.

Skills

Pharmacy Management

Regulatory Compliance

Project Management

Data Analysis

Educational Program Development

Education

Bachelor’s or Associate’s degree in health sciences

Degree in business or healthcare administration

Degree in health information management

Tools

Pharmacy Benefit Management Systems

Data Reporting Tools

Job description

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, interpret, and implement 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.
• Lead relationship with PBM to understand contractual requirements and ensure vendor is meeting expectations.
• Monitor reporting and analysis of delegated functions and any escalation of concerns for engagement and intervention.
• Perform complex research and analysis related to compliance with federal, state and local pharmacy regulations in order to support Clinical Services operational compliance.
• Interpret and educate Pharmacy team members regarding NCQA and/or URAC standards and compliance expectations, and monitor compliance and report out compliance.
• Facilitate compliance and quality assurance audits periodic assessments to ensure adherence with contractual and regulatory requirements.
• Design, develop, and maintain pharmacy benefit reporting tools.
• Provide 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.
• Create project definitions and scopes, develop recommendations, implement action plans, complete testing, and assist 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.