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Manager, Pharmacy Benefits & Formulary

Company: SCAN Healthplan
Location: Long Beach
Posted on: June 12, 2021

Job Description:

Manager, Pharmacy Benefits & Formulary

  • Long Beach, CA
  • Full-time

About SCAN

As one of the nation's largest not-for-profit Medicare Advantage plans, serving more than 200,000 members in California, SCAN Health Plan has been a mission-driven organization dedicated to keeping seniors healthy and independent for over 40 years. SCAN employees are passionate about what they do, and understand that success is based on achieving the mission. Employees are afforded with the training and tools necessary to do their jobs and are rewarded for their efforts and recognized as experts in their fields. To learn more, visit scanhealthplan.com or follow us on social media: LinkedIn; Facebook; and Twitter.

The Opportunity

This position will play a central role in leading formulary management and Rx benefit implementation for a senior-focused Medicare Advantage Plan. This position is accountable for providing leadership and direction to the Formulary and Benefits team, ensuring regulatory compliance with respect to formulary design, benefit administration and implementation with the PBM, transition program, P&T, related marketing materials, website content for all business lines, pharmacy network and CMS's regulatory audits. The Manager has accountability for fulfilling the organization's mission, managing cost of pharmacy care, growth and profitability. The Manager stays abreast of pharmacy, PBM and payer industry changes, best practices, and CMS's rules and regulations.

You Will

  • Ensure regulatory compliance with P&T operations, Formulary & Rx Benefit Administration, Transition Program, annual Part D bid submission process, pharmacy related marketing materials, website content, pharmacy network and CMS's regulatory audits.
  • Provide guidance and oversight to managers, supervisors, clinical pharmacists and pharmacy benefit administrators.
  • Oversee formulary and Rx benefits development, maintenance and implementation, P&T, opioid POS safety edits, transition program, Part D bid submission, pharmacy related marketing materials, website content and pharmacy network.
  • Monitor pipeline and the payer industry changes to identify high Part D impact drugs. Manage Part B drug trend and provide Network Management support
  • Train staff on job related functions and refresher courses as updates to processes or requirements occur.
  • Coach and mentor supervisors, clinical pharmacists and pharmacy benefit administrators.
  • Instill a culture of continuous process improvement, efficiency, collaboration, operational excellence and compliance amongst team.
  • Maintain strong rapport with PBM representatives such that department and organization goals and needs are met.
  • Manage performance of PBM as it relates to assigned responsibilities.
  • Oversee PBM operations to ensure high service level to SCAN and our members.
  • Serve as the clinical subject matter expert for respective area, providing guidance, as needed.


Your Qualifications

  • Pharm D. Degree required.
  • Active and unrestricted California Registered Pharmacist license required.
  • 5+ years of progressive experience in a managed care setting, resulting in a similar leadership role required.
  • Residency Program in Managed Care, Drug Information, Geriatric Pharmacy, or Pharmacy Practice required.
  • Proven experience with a performance-driven management style.
  • Expertise in Medicare Part D.
  • Proven project management experience applying industry methodologies and practices.
  • Ability to manage and adapt to a significant change.
  • Strong leadership skills, including excellent interpersonal, communications, problem- solving and negotiating skills.
  • Ability to work cross-functionally and collaboratively across the organization.
  • Ability to think strategically and act tactically.
  • Technologically savvy and able to utilize information systems effectively.
  • Proven ability to mentor and coach team members.

What's in it for you?

  • A competitive compensation and benefits program
  • An annual employee bonus program
  • Generous paid-time-off (PTO)
  • Ten paid holidays per year
  • Excellent 403(b) Saving Plan, providing up to 4% match and vesting after three years
  • Casual attire
  • Telecommute opportunity
  • A work-life balance and much more!

We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!

At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.

SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employee will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

Keywords: SCAN Healthplan, Long Beach , Manager, Pharmacy Benefits & Formulary, Other , Long Beach, California

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