Job Description:

• Manage Part D Coverage Determinations, Appeals, and Grievances: Apply clinical expertise, plan benefits, and CMS regulatory requirements.
• Lead Targeted Provider and Member Outreach: Conduct clinical outreach to prescribers, pharmacies, and members.
• Deliver Medication Therapy Management Services and Quality Initiatives: Perform comprehensive and targeted medication reviews.
• Manage Benefit Build and Member-Facing Materials: Assist with annual pharmacy benefit build activities.
• Oversee PBM delegated operations and Regulatory requirements: Ensure compliance with contractual and CMS requirements.

Requirements:

• Minimum of 3 years of pharmacy experience at a health plan, Pharmacy Benefit Manager (PBM), or managed care organization.
• Demonstrated experience conducting MTM or equivalent clinical pharmacy programs with documented member outcomes.
• Bachelor's degree in Pharmacy or a related health science discipline.
• Active and unrestricted Pharmacist license in the applicable state(s).

Benefits:

• Health insurance
• Retirement plans
• Paid time off
• Flexible working arrangements
• Professional development