Manager, Pharmacy Experience and Access

SCAN Health Insurance•Long Beach, CA

2d•$147,900 - $214,030•Remote

About The Position

This position will play a central role in designing, implementing, and overseeing the Part D program, including coverage determinations and appeals for a senior-focused Medicare Advantage Plan. The Manager will be responsible for ensuring CMS compliance, operational excellence, and enhanced member experience. The Manager will provide leadership, strategic direction, and oversight to the team while ensuring effective management of the contracted pharmacy benefit manager (PBM), including PBM performance, formulary operations, utilization management processes, and ongoing compliance requirements.

Requirements

Graduate or Advanced Degree, Pharm D required.
Active Pharmacist License required.
Demonstrated knowledge of and experience monitoring Medicare Part D regulations, required.
5+ years or more of managed care pharmacy experience; or equivalent experience in a managed care setting, strongly preferred.
1-2 years leadership/management experience strongly preferred.
Knowledge and experience with organizing quality improvement initiatives and presenting findings to leadership.
Leadership - Lead and inspire teams to achieve performance goals, offering guidance and support
Problem Solving - Good problem-solving skills
Communication - Good communication and interpersonal skills
Strong analytical, problem-solving, and decision-making abilities
Ability to think strategically while executing tactically
Detail-oriented and highly adaptable to a fast-paced, evolving environment
Demonstrated ability to manage multiple priorities simultaneously
Proven leadership, manager, and accountability skills
Strong organizational, time management, and project management capabilities
Self-starter with a resourceful and innovative mindset
Effective across cross-functional teams and collaborative environments
Exceptional verbal, written, and interpersonal communication skills
High commitment to professionalism and customer service
Computer proficiency required to perform essential job functions
Communication & Professionalism - Exceptional verbal, written, and interpersonal communication skills
High commitment to professionalism and customer service
Computer proficiency required to perform essential job functions
A background check is required.

Nice To Haves

Completion of a PGY1 and/or PGY2 residency or equivalent clinical practice experience preferred.

Responsibilities

Lead and support CMS Part D program audits and data validation audits; manage audit universe files; including HPMS reporting requirements and ensure ongoing audit readiness through mock audits, compliance monitoring, and post-submission reviews.
Lead the Pharmacy Experience & Access team to oversee and optimize PBM delegated programs (DUR, FWA, Patient Safety Analysis, Opioids) for compliance and effectiveness.
Ensure CDAG operations (e.g., coverage determinations and appeals) are timely and compliant with CMS’s regulations.
Implement new CMS programs and process enhancements that strengthen compliance, efficiency, and member experience through routine tracking and trending.
Maintain up-to-date clinical policies and desktop procedures, ensuring internal adherence across clinical operations.
Serve as subject matter expert for Part D coverage determinations and redeterminations.
Stay current with Medicare Part D regulations by attending CMS calls and applying released guidance to maintain compliance.
Oversee PBM operations, collaborating on process improvements and CMS updates to support quality performance and enhance member experience.
Provide supervision, development, and coaching to pharmacists, technicians, and support staff, fostering a culture of process improvement, operational excellence, and compliance.
Oversee Formulary and Utilization Management and implementation.
Supervises/Manages Others (i.e. hires, performance reviews, corrective action, etc.)
Actively support the achievement of SCAN’s Vision and Goals.
Other duties as assigned.