Pharmacy Program Manager, Michigan

Mclaren-Health-Care; Flint (MI); On-site; USD 110,000 - 140,000; Full time

Job summary

McLaren Health Care is seeking a Pharmacy Program Manager to lead the end-to-end oversight of its PBM vendor relationship, contract compliance, and Rx program implementation across all lines of business. The role partners with clinical, compliance, quality, finance, and regulatory teams to drive improved member outcomes and program performance.

The candidate will bring expertise in Medicaid/Medicare pharmacy requirements, PBM vendor management, and project leadership across multi-stakeholder

Qualifications

• Bachelor's degree in pharmacy, healthcare administration, business, or related field; or an Associate degree and two years related experience; or GED with four years related experience.
• Three years’ experience in pharmacy program operations, managed care, or PBM environment, including two years with Medicaid or Medicare Part D.
• Two years’ experience with PBM vendor management and contract oversight, including multi-stakeholder implementations.

Responsibilities

• Oversee end-to-end PBM vendor relationship, contract compliance, and Rx program implementation across lines of business.
• Coordinate cross-functional activities with clinical, compliance, quality, finance, and regulatory teams to optimize pharmacy benefit performance.
• Ensure Medicaid, Medicare, and Commercial lines meet quality and regulatory requirements.
• Lead project management efforts for multi-stakeholder pharmacy program initiatives.

Skills

Pharmacy program ops

PBM vendor management

Contract oversight

Project management

Cross-functional collaboration

Medicaid/Medicare knowledge

Education

Bachelor's degree in pharmacy

Associate degree in pharmacy

High school diploma with related experience

Tools

PBM platforms

Data analytics tools

Reporting tools

Project management software

Job description

McLaren Health Care, headquartered in Grand Blanc, Michigan, is a $7.3 billion, fully integrated health care delivery system committed to quality, evidence-based patient care and cost efficiency. The McLaren system includes 12 hospitals in Michigan, ambulatory surgery centers, imaging centers, a 640-member employed primary and specialty care physician network, commercial and Medicaid HMOs covering more than 732,838 lives in Michigan and Indiana, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, a National Cancer Institute-designated comprehensive cancer centers. McLaren has 20,000 full-, part-time and contracted employees and more than 113,000 network providers throughout Michigan, Indiana and Ohio.

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.

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
• On Call: No

Equal Opportunity Employer

McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status, national origin, disability, genetic information, height or weight, protected veteran or other classification protected by law.

McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employmentwithout regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status,national origin, disability, genetic information, height or weight, protected veteran or other classificationprotected by law.