Pharmacy Program Manager, Michigan

McLaren Health Care; Flint (MI); On-site; USD 95,000 - 120,000; Full time

Job summary

McLaren Health Plan in Michigan seeks a Pharmacy Program Manager to oversee the PBM vendor relationship, contract compliance, and Rx program implementation across all lines of business. This role ensures contractual obligations are met and pharmacy programs are effectively implemented to improve outcomes.

The incumbent will collaborate with clinical, compliance, quality, finance and regulatory teams to optimize pharmacy benefits and member outcomes, serving as the operational bridge to the PBM

Qualifications

• Bachelor's degree in pharmacy, healthcare administration, business, or related field; or an Associate degree in pharmacy, healthcare administration, business, or a related field and two (2) years related experience; or a High School Diploma or equivalent (GED) and four (4) years related experience.
• Three (3) years’ experience in pharmacy program operations, managed care, or PBM environment, including two (2) years’ experience working with Medicaid managed care pharmacy requirements and/or Medicare Part D pharmacy benefit administration.
• Two (2) years’ experience with PBM vendor management and contract oversight including project management with experience managing multi-stakeholder implementations.

Responsibilities

• Oversee PBM vendor relationship and contract compliance across all lines of business.
• Ensure Rx program implementation and operational bridge between McLaren Health Plan and PBM partner.
• Drive quality initiatives for Medicaid, Medicare, and Commercial plans.
• Collaborate with clinical, compliance, quality, finance and regulatory teams.

Skills

PBM vendor management

Contract oversight

Project management

Education

Bachelor's degree in pharmacy, healthcare administration, business, or related field

Associate degree in pharmacy, healthcare administration, business, or related field and two years related experience

High School Diploma or equivalent (GED) with four years related experience

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 Pharmacy Program Manager, 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 Pharmacy Program Manager is responsible for the end-to-end oversight of McLaren Health Plan's Pharmacy Benefit Manager (PBM) vendor relationship, contract compliance, and Rx program implementation across all lines of business. This position serves as the operational bridge between McLaren Health Plan and its PBM partner, ensuring contractual obligations are met, pharmacy programs are implemented effectively, and quality initiatives for Medicaid, Medicare, and Commercial lines of business are driven to successful outcomes. The Pharmacy Program Manager will work cross-functionally with clinical, compliance, quality, finance, and regulatory teams to optimize pharmacy benefit performance and member outcomes.

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; or a High School Diploma or equivalent (GED) and four (4) years related experience.
• Three (3) years’ experience in pharmacy program operations, managed care, or PBM environment, including two (2) years’ experience working with Medicaid managed care pharmacy requirements and/or Medicare Part D pharmacy benefit administration.
• Two (2) years’ experience with PBM vendor management and contract oversight including project management with experience managing multi-stakeholder implementations.

Preferred

• Project Management Professional (PMP) certification or equivalent experience.
• A valid, current, unrestricted Michigan license or certification as either a Certified Pharmacy Technician (CPhT) or Registered Pharmacist (RPh)
• Two (2) years’ experience with NCQA Health Plan Accreditation and/or URAC standards.
• Two (2) years’ experience with CMS Star Ratings, HEDIS pharmacy measures, and Medication Therapy Management programs.
• Two (2) years’ experience in Michigan Medicaid (MDHHS) managed care contract requirements and CHAMPS.
• Two (2) years’ experience with pharmacy data analytics platforms, reporting tools, or business intelligence systems.
• Two (2) years’ managed care experience across multiple lines of business (Medicaid, Medicare, Commercial).

Additional Information

• Schedule: Full-time
• Requisition ID: 26004102
• Daily Work Times: 8:30AM - 5:00PM
• Hours Per Pay Period: 80
• On Call: No
• Weekends: No