Senior Clinical Pharmacy Program Lead — Managed Care

Harris Health; Houston (TX); On-site; USD 140,000 - 180,000; Full time

Job summary

Community Health Choice, Inc. is seeking a Clinical Pharmacy Program Manager to lead integrated clinical pharmacy services and oversee pharmacy benefit administration.

You will supervise clinical pharmacists, technicians, and students, and drive medication-management initiatives within the health plan. The role requires strong experience in drug utilization management, Medicare/Medicaid, and collaboration with Care Management and Utilization Management teams; a PharmD or TX license is required

Qualifications

• Doctor of Pharmacy degree or active Texas Pharmacist license required/preferred.
• Minimum 5 years of applicable managed care pharmacy experience.
• Experience with drug utilization management is required; Medicare/Medicaid exposure valued.
• Strong Excel and data analysis skills; SQL exposure preferred.
• Excellent communication, leadership, and project-management capabilities.

Responsibilities

• Review medical and pharmacy benefit claims data for trends to improve UM strategies.
• Perform prior authorization reviews, appeals, and non-formulary exceptions.
• Analyze utilization data to identify cost-savings opportunities.
• Oversee prior authorization criteria and delegated UM functions.
• Serve as clinical resource for Care Management, Utilization Management, and related projects.
• Manage the Medication Therapy Management (MTM) program.
• Supervise clinical staff and students as assigned.
• Contribute to departmental goals and process-improvement initiatives.

Skills

Drug Utilization Management

SQL

Advanced Excel

Visio

Leadership

Attention to Detail

Communication

Interpersonal Skills

Independent Work

Education

Doctor of Pharmacy degree

Texas Pharmacist license

Bachelor's degree in Pharmacy

Tools

Microsoft Office

SQL

Visio

Job description

Community Health Choice, Inc. is seeking a Clinical Pharmacy Program Manager to lead integrated clinical pharmacy services and oversee pharmacy benefit administration.

You will supervise clinical pharmacists, technicians, and students, and drive medication-management initiatives within the health plan. The role requires strong experience in drug utilization management, Medicare/Medicaid, and collaboration with Care Management and Utilization Management teams; a PharmD or TX license is required