Pharmacy Revenue Integrity Manager

memorialhealthcare

United States

On-site

USD 140,000 - 210,000

Full time

3 days ago

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Job summary

Memorial Health System is seeking a Pharmacy Business Manager in Miramar, FL, to optimize outpatient pharmacy revenue and support payer and pharmaceutical company relationships. The role collaborates with pharmacy leadership, revenue cycle, finance, and compliance to protect revenue integrity and enable sustainable growth while upholding patient care standards.

Responsibilities include analytics development, contract management, and leadership of pharmacy staff to improve reimbursement

Qualifications

Requires advanced analytical judgment and knowledge of pharmacy reimbursement.
Experience with payer contracts, credentialing, and revenue cycle management.
Strong ability to translate payer, regulatory, and reimbursement requirements into actionable workflows.

Responsibilities

Guide financial and utilization analytics, develop dashboards and KPIs.
Support contract review, credentialing, and re-credentialing with payers and PBMs.
Engage payers and manufacturers to optimize access, reimbursement, and contract compliance.
Monitor reimbursement performance, including denials and write-offs, with root-cause analysis.
Establish governance to identify and resolve revenue leakage across medication lifecycle.
Provide leadership over pharmacy staff related to revenue cycle and profitability reviews.
Collaborate with clinical and finance leaders to align patient access, quality and growth objectives.