Remote Pharmacy Experience & Access Lead (Medicare Part D)

SCAN Health Insurance; United States; Remote; USD 148,000 - 214,000; Full time

Benefits offered by this job

Remote work

Annual bonus program

Wellness program

PTO

11 holidays + floating + birthday

401(k) with employer match

Tuition reimbursement

Meaningful work for members

Job summary

SCAN Health Insurance is seeking a Manager for the CMS Part D program to provide leadership, strategic direction, and oversight for coverage determinations, PBM operations, and CMS compliance. You will lead audits, ensure data validation, and optimize member experience within a senior-focused Medicare Advantage plan.

You will supervise pharmacists and staff, maintain clinical policies, and implement process improvements to strengthen compliance and operational excellence.

Qualifications

• Graduate or Advanced Degree, PharmD required.
• Active Pharmacist License required.
• Completion of a PGY1 and/or PGY2 residency or equivalent clinical practice preferred.
• Experience with Medicare Part D regulations required.
• 5+ years of managed care pharmacy experience; 1-2 years leadership preferred.

Responsibilities

• Lead CMS Part D program audits and data validation; manage audit universe and HPMS reporting.
• Oversee PBM delegated programs (DUR, FWA, Patient Safety Analysis) for compliance and effectiveness.
• Ensure Part D coverage determinations and redeterminations are timely and CMS compliant.
• Maintain up-to-date clinical policies and procedures; supervise pharmacists and staff.
• Stay current with CMS Part D regulations by attending CMS calls and applying guidance.

Skills

Leadership

CMS Part D

Audits

Team management

Data validation

Communication

Strategic thinking

Education

PharmD

PGY1/PGY2 residency

Tools

HPMS

PBM systems

Job description

SCAN Health Insurance is seeking a Manager for the CMS Part D program to provide leadership, strategic direction, and oversight for coverage determinations, PBM operations, and CMS compliance. You will lead audits, ensure data validation, and optimize member experience within a senior-focused Medicare Advantage plan.

You will supervise pharmacists and staff, maintain clinical policies, and implement process improvements to strengthen compliance and operational excellence.