Medicare Pharmacy Programs Manager or Sr. DOE

Remote in ID, OR, UT, WA

Primary Job Purpose

The Medicare Pharmacy Programs Manager or Sr will represent Pharmacy Services in Medicare business relationships in partnership and on behalf of the Pharmacy Leadership Team. Establish and lead pharmacy programs for Medicare program governance and workstream meetings to enhance Medicare Advantage and Medicare Part D program offerings. Develop and maintain the pharmacy portfolio or products, projects, and initiatives to support the full scope of Government Programs for pharmacy benefit management work and activities. Create and maintain reporting functions and key performance indicators. Share status updates and value generation strategies and progress across all areas of Pharmacy to support Medicare Advantage programs. Represent and advocate for resource needs and organizational support on Medicare programs and initiatives.

General Functions and Outcomes

• Work closely with project sponsor(s), cross-functional teams, and project managers to plan and develop scope, deliverables, required resources, work plan, budget, and timing for new initiatives.

• Effectively manage internal/external stakeholder relationships, ensuring the focused pursuit of desired outcomes.

• Manage program and project teams to identify risks and opportunities across multiple initiatives or workstreams to ensure program goals are reached. 

• Educate and train the leadership, staff, business associates and other stakeholders regarding new program elements, process and implementation.

• Maintain a system for ongoing data/statistical reporting and program assessment. Develop and communicate program documents, project plans, etc.

• Effectively collaborate with internal program leaders, senior management, and cross-functional managers/directors to develop program monitoring and assessment protocols for evaluation and improvement. Recommend program and process changes as appropriate.

Minimum Requirements

• Ability to think analytically, effectively applying project management and financial techniques, and providing recommendations to management using critical thinking and sound judgment.

• Ability to coordinate cross-functionally with all levels of the organization for the purpose of driving solutions and resolving issues in a timely and effective manner.

• Proficiency in effectively managing high-profile projects and reporting barriers to program deliverables. Strong analytical skills, with the ability to analyze complex data and situations, learn quickly and create options, recommendations and action plans.

• Ability to resolve issues and build consensus among groups of diverse stakeholders.

• Experience in independently defining, developing, managing and reporting on processes and metrics.

• Ability to accomplish results through others by establishing relationships, effective controls and monitoring processes.

• Ability to partner effectively with external partners/vendors.

• Familiarity with health plan and clinical terminology, operations and trends. 

Normally to be proficient in the competencies listed above

The Medicare Pharmacy Programs Manager would have a Bachelor’s Degree in Business, Health Care Administration, or related field (Masters preferred), and 8 years’ experience with project and/or program management in healthcare, healthcare insurance operations or other large, complex industry. Experience in Medicare Advantage plans, Medicare Part D programs, and Centers for Medicare & Medicaid Services (CMS) regulations is preferred . May have equivalent combination of education and experience. 

The Medicare Pharmacy Programs Manager Senior would have a Bachelor’s Degree in Business, Health Care Administration, or related field (Masters preferred), and 10 years’ experience with project and/or program management in healthcare, healthcare insurance operations or other large, complex industry. Previous leadership experience and experience in Medicare Advantage plans, Medicare Part D programs, and Centers for Medicare & Medicaid Services (CMS) regulations is preferred . May have equivalent combination of education and experience

#LI-Remote

The expected hiring range for a Medicare Pharmacy Programs Manager is $99,500 - $134,600, and for a Medicare Pharmacy Programs Manager Sr is $132,600 - $179,400 depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location.

The bonus target for each position is 15 %.

The current full salary range for this role is $93,000 - $153,000 for Medicare Pharmacy Programs Manager, and is $124,000 - $203,000 for Medicare Pharmacy Programs Manager Sr.

Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:

• medical, dental, and vision coverage for employees and their eligible family members

• annual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)

• paid time off varying by role and tenure in addition to 10 company holidays

• up to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)

• up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)

• one-time furniture and equipment allowance for employees working from home

• up to $225 in Amazon gift cards for participating in various well-being activities. for a complete list see our External Total Rewards page.

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com . Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy . As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.