Manager, Clinical Pharmacy Operations

Position Purpose : The Manager of Clinical Pharmacy Operations is responsible for developing, implementing and administering clinical pharmacy tools and programs to support corporate and regional drug utilization and financial goals. Key Detail s: This position is fully remote. The ideal candidate will have people leadership experience and a strong background in managed care or PBM clinical pharmacy operations, including clinical edits, drug utilization review, prior authorization, claims adjudication, or formulary management. Experience working with Medicaid requirements, pharmacy claims standards, PBM partners, and cross-functional teams is strongly preferred. Directs and manages clinical pharmacy activities through subordinate staff to enhance the quality of pharmaceutical care and promote cost-effective utilization of pharmaceuticals for members. Responsible for the development, implementation and ongoing maintenance of clinical pharmacy programs including but not limited to clinical quality assurance programs, formulary management, drug utilization review, compliance and/or education. Coordinates clinical efforts with other department functional areas to ensure implementation of cohesive programs. Performs quality assurance monitoring of staff to ensure best practices are met and validates that clinical pharmacy programs meet applicable regulatory and compliance standards, such as Medicare Star ratings, HCQA HEDIS measures, and/or regulations, etc. Oversees and/or develo