Manager, Pharmacy Operations - Michigan
About The Position
McLaren Health Plan (MHP) is a high-performance company dedicated to helping people live healthier lives. MHP is a Managed Care Organization serving Michigan residents with individual and family plans, as well as Medicaid and Medicare plans. MHP is accredited by the National Committee for Quality Assurance (NCQA) and fosters an open, cooperative, and dynamic environment where employees and the health plan can thrive. As an employee, you will be part of a dynamic organization where all employees are considered leaders in driving the organization forward and delivering quality service. The Manager of Pharmacy Operations is a licensed clinical leadership position responsible for the strategic oversight and day-to-day management of McLaren Health Plan's pharmacy program across all lines of business (LOB), including Medicaid, Medicare Advantage, and Commercial products. This role serves as a clinical subject matter expert and operational leader, ensuring the delivery of high-quality, cost-effective, and compliant pharmacy services. Reporting to the Director, the Manager position will collaborate closely with medical management, quality, compliance, finance, and external Pharmacy Benefit Manager (PBM) partner to drive pharmacy program excellence.
Requirements
- Bachelor’s degree in pharmacy, healthcare administration, business, or a related field; OR an Associate degree in pharmacy, healthcare administration, business or a related field and two (2) years’ related experience.
- Valid, current, unrestricted Michigan Registered Pharmacist (RPh).
- Five (5) years of progressively more responsible pharmacy experience.
- Experience and knowledge of HMO, PPO, TPA, PHO, and Managed care functions.
- At least two (2) years' experience with formulary management, drug utilization review, and clinical program development.
- At least two (2) years in a supervisory role leading or assisting in all phases of effective supervision (i.e. Recruitment, performance management, training).
Nice To Haves
- Two (2) years’ Experience with NCQA Health Plan Accreditation and/or Utilization Review Accreditation Commission (URAC) standards.
- PGY-1 or PGY-2 Managed Care Pharmacy Residency experience.
- Familiarity with Michigan Medicaid MDHHS contract compliance requirements and CHAMPS system.
- Proficiency with pharmacy claims data, reporting tools, and population health analytics platforms.
- Familiarity with McLaren Health Plan, McLaren Health Care, or McLaren Integrated HMO Group products.
Responsibilities
- Strategic oversight and day-to-day management of McLaren Health Plan's pharmacy program across all lines of business (Medicaid, Medicare Advantage, and Commercial products).
- Serve as a clinical subject matter expert and operational leader for the pharmacy program.
- Ensure the delivery of high-quality, cost-effective, and compliant pharmacy services.
- Collaborate with medical management, quality, compliance, finance, and external Pharmacy Benefit Manager (PBM) partner to drive pharmacy program excellence.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
Associate degree
